(US) Wholesale Client Registration Form
We are working through the request forms and will email you the access code for our wholesale website, terms & availability once application is verified & approved. We hope to update our wholesale website availability weekly. We look forward to working with you all. Thank You - Las Selvas
*
1.
Your Business Name
(Required.)
*
2.
Full Name
(Required.)
*
3.
Phone Number
(Required.)
*
4.
Email
(Required.)
*
5.
Instagram Handle
(Required.)
6.
Website (*Optional*)
*
7.
Sellers Permit Number/Resale Tax ID#
(Required.)
*
8.
What State Is Your Buisness In ?
(Required.)
*
9.
Buisness Type (Select All That Apply)
(Required.)
Brick & Mortar Store
Online Store
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10.
Any questions or comments ?