Direct
dealer application
Billing Information
Business Name
Name
Address
City / State / Zip Code
Email Address
Phone Number
Ship To
(if different)
Same as billing?
Business Name
Name
Address
City / State / Zip Code
Phone Number
Business Type
(select all that apply)
Brick & Mortar
Breaker
Online
How long have you been in business?
Ebay store name
Business information
State Tax ID Resale Number (or equivalent)
Upload File
Please upload state tax document
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Do you set up at industry trade shows? If so, list those attended regularly
Trade References
How do you acquire your Leaf Products at this time?
List 3 Leaf Products you're interested in purchasing
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