Wholesaler Application

Company Name*
First Name*		Last Name*
Address*		City*
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Zip/Postal Code*
Telephone*
Email*
How did you hear about our products?
Sales Tax ID*		Number of Years in Business*
How do you plan on selling/distributing beco products? Please Select Domestic (US) International
Retail stores?*	No Yes
Retail business type?	Please Select Distributor E-retailer Independent Juvenile/Specialty Mass/Discount Merchandiser Other:
Do you sell online?*	No Yes   If "Yes", please provide your web address:
Other brands you carry?*
Other information about your business and objectives