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Wholesale Account Registration
Business Name
Business Email
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Business Phone
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Store Address
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City
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State
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Zip Code
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Contact First Name
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Contact Last Name
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Contact Email Address
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Contact Phone
Tax ID Number
Type of Business
Bakery
Bar/Brewery
Boutique
Candy Store
Co-op
Convenience Store
Drug Store/Pharmacy
Gift Shop
Grocery
Online Retailer
Restaurant/Cafe
Retail
Salon
Vineyard/Winery
Other
Do you have multiple store locations?
Yes
No
All locations you intend to sell
Street Address
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City
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State
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Zip Code
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Do you sell online or in-store?
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Online Only
In-store Only
Both Online and In-store
Business Website
Social Media Accounts
Facebook
Instagram
Tiktok
Facebook
Instagram
Tiktok Username
Do you sell other brands of popcorn?
Yes
No
Please list the other brands.
How did you hear about us?
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Event
Friend/Family
Online Search (Google, etc)
Received as Gift
Referral from Another Business
Referral from Customer
Social Media
Other
Desired Payment Terms
Credit Card
Check
Net 15
Net 30
Password
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Confirm Password
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