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 Code Phone Number
Phone Number *

Area Code Phone Number

Billing Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Shipping Address *

Street Address Line 1
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Street Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Website URL *
# Years in business
Owner/President *

First Name Last Name
E-mail *
Tax Exemption
Reseller Permit Copy
Upload a copy now, or email to us prior to your first order
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 Name Last Name
Email *
example@example.com
Phone Number *

Area Code Phone Number
Accounts Payable Information
Name *

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

Area Code Phone Number
Business Classification
Intent for retail *

eCommerce Brick & Mortar Location Both
Please check all that apply for your business so that we can better serve your needs!

Brewery Winery Specialty Food Specialty Grocery Lifestyle Store Natural Health Food Wine or Liquor Store Yoga or Spa Gift Basket Company Gift Shop Candy Store Candy Store Department Store Coffee Shop Hotel Museum E-Commerce
Retail Description
Geographical Location

Urban Suburban Rural Online
Demographics
Square Footage
Average Sale ($ amount)
Do you currently sell chocolate?

Yes No
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 :)
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Whole Sale Account Application