New Wholesale Application

Whole Sale Account Application

We would love to provide you with our delicious single origin chocolate and cacao. With our wholesale accounts we strive to directly work with you to ensure optimal satisfaction and transparency. First, please fill out the following to the best of your ability to help build a strong partnership with you. We look forward to supplying you with chocolate and/or our bean to bar making classes!
Business Information
Business Name*
Fax Number

Area CodePhone Number
Phone Number*

Area CodePhone Number
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Shipping Address*

Street Address Line 1

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Street Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Website URL*
# Years in business
Owner/President*

First NameLast Name
E-mail*
Tax Exemption
Reseller Permit Copy

Upload a File
Upload a copy now, or email to us prior to your first order Cancelof
Tax ID #*
For wholesale distribution & tax exemption
Shipping Account #
If you would like us to bill your corporate account-if not leave blank
Buyer Information
Name of authorized buyer*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Accounts Payable Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Business Classification
Intent for retail*

eCommerceBrick & Mortar LocationBoth
Please check all that apply for your business so that we can better serve your needs!

BreweryWinerySpecialty FoodSpecialty GroceryLifestyle StoreNatural Health FoodWine or Liquor StoreYoga or SpaGift Basket CompanyGift ShopCandy StoreCandy StoreDepartment StoreCoffee ShopHotelMuseumE-CommerceOther
Retail Description
Geographical Location

UrbanSuburbanRuralOnlineOther
Demographics
Square Footage
Average Sale ($ amount)
Do you currently sell chocolate?

YesNo
If YES ^ which brands to you currently offer?
How much display space do you have to spare? (Cubic Inches)
How did you hear about us?!
Which of our products/services are you interested in?
Either way, we will send you our wholesale price list if you'd desire!
We are looking forward to developing our relationship with you! We are your middle-people to farm-direct, bean to bar chocolate :)
Should be Empty:

Whole Sale Account Application