Swaddlesport.com

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Wholesale Form

This Application should take 5 to 10 minutes to complete. ALL INFORMATION PROVIDED WILL BE HELD IN STRICT CONFIDENCE. Required fields are marked with a star(*).

COMPANY INFORMATION:
Would you like to receive e-mails about new products?	Yes No
What is the specialty of your store?	Maternity Baby Toys Bookstore Sports Gifts Other
*Company Name:
* Address 1:
Address 2:
* City:		* State:	* Zip:
* Phone:		* Fax:
Website:

* Manager’s Name:		* Manager’ E-mail:
Buyer’s Name (if different from manager):		Buyer’s E-mail:

* Federal I.D. #
* State of Reseller License:
* Reseller License # or Seller’s Permit #:

TRADE REFERENCES:
Reference # 1:
* Company Name:
* Address 1:
Address 2
* City:		* State:	* Zip:
* Phone:		* Fax:
* Account #:

Reference # 2:
* Company Name:
* Address 1:
Address 2:
* City:		* State:	* Zip:
* Phone:		* Fax:
* Account #: