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Wholesale Account Application

Company Name *

Mailing Address *

Street Address (or PO Box)
City, State, Zip Code + 4

Business Phone *

Fax (Optional)

Contact Email *

(For invoices, new product announcements, newsletters, promotional announcements)

Website *

Shipping Address

(If different than mailing address)

Street or PO Box
City, State, Zip Code + 4

Date Business Established *

Resale Number *

Please Note: If your state does not have a Resale ID, please enter "N/A for <Your State>"

Federal Tax ID *

Type of Business *

Business Location *

Principal Contact Name & Title *

Name
Title

Primary Contact

(If different than Principal)

Accounts Payable Contact

(If different than Primary/Principal)

Primary Contact Email

(If different than Business Email)

Primary Contact Phone

(If different than Business Phone)

Preferred Shipping Method *

May We Expedite Shipping Your Backorders by Shipping Without a Phone Call? *

Most orders over $500 receive free shipping. By checking Yes, you will receive your backorder with free shipping.

By clicking Agree below, I acknowledge I have provided all factual information above to the best of my knowledge, and I am entering into a Wholesale Agreement with Togl LLC. I acknowledge that this information will be kept with Togl, for the sole purpose of remaining within this agreement. If any changes occur to the provided information, I acknowledge I am responsible for updating Togl LLC with any changes. I acknowledge that 12 months of inactivity will result in account deactivation, but that in most cases deactivated accounts can be reinstated upon submission of an updated wholesale account application. *

Signature

Date

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