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Wildbeary Wholesale Buyer's Registration and Password Request Form

Instructions

You must be a qualified buyer for a retail outlet, gift basket company, restaurant or cafe with a valid sellers permit (unless your state does not issue sellers permits. Alternate directions listed below) in order to receive a password to this WHOLESALE ONLY website.

If you are a reseller, fill out the following information to receive your password. Please allow our staff 24 to 48 hours to review your registration form and email your personal passwords. If you need information immediately, please call (888) 231-1699.

Items marked with an asterisk (*) are required.

State SALES Tax or Resellers ID # (Federal EIN if none)*

Contact Information*
*All fields must be filled in

First Name*

Last Name*

Company

Address*

City*

State*

Postal Code*

Country*

Email*

Day Phone*

Evening Phone

Website (if you have one):

Second Website?

What Type of Business Do You Have? *

	Gift Store
	Gift Basket Company
	Food Service, Restaurant or Cafe
	Misc. Retail Outlet
	Corporate Account Buyer
	Exporter
	Other (none of the above). Please list specifics in company description below.

How Long Have You Been in Business? *

	Less than one year
	One to three years
	Three to six years
	Over six years

Please tell us a little bit about your business

How did you discover this website?

If you found Wildbeary through a on-line search, what search terms or products were you looking for?

Have you purchased or received WildBeary products previously?

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Note: All prices in US Dollars

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