WHOLESALE APPLICATION
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First Name:
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Last Name:
Company:
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Address 1:
Address 2:
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City:
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State/Province/Region :
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Zip/Postal Code :
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Country:
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Daytime Phone:
Evening Phone :
Fax:
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Tax ID/SSN
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Website URL:
LOGIN INFORMATION
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Email:
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Password:
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Confirm Password :
DESIRED PRICING LEVEL
Wholesale
Please describe your business, where our products will be sold, and any other pertinent information to your application.
CERTIFICATE OF RESALE
Please upload your electronic certificate of resale using the field above.
AGREEMENT
All sales are final. Terms & Conditions: If you are giving a deposit, the rest of the balance will be charged to this credit card as soon as your order is ready. You are authorizing us to charge Shipping & Taxes if applicable. If paying via credit card & order is over $1,000 please via a copy of your drivers license to 954-5930 If paying by check please print this order and mail along with your check to: Expose Yourself USA 6033 NW 31 Ave Fort Lauderdale, FL 33309 United States
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I have read, understand, and agree to the above agreement. :