Wholesale Application

Name: SimplyHemp Shop
Price range: wpblogsupport

Primary Contact Info
Contact Information
- Mr.
- Mrs.
- Ms.
- Dr.
- Suffix
- Sr.
- Jr.
First Name Middle Name Last Name
Work Phone
Fax Phone
Mobile Phone
Email
Company Information
Where and How do you plan to sell Simply Hemp Products? [Check all that apply]:
- Retail
- Online Commerce
- Business 2 Business
- To Government
- To Education
- Other
Job Title
Company Name
Types of Goods Sold
Years in Cooperation
Business Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
TN TAX INFORMATION [For seller in TN. Also, please e-mail a copy of your Reseller’s Permit along with application
TENNESSEE applicants ONLY: please provide the information below. Ignore this page if company not based in TN.
Company Name
Address
Reseller Account Number
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