Become a Paddywax Retailer
Thank you for your interest in Paddywax! Tell us a bit about your store and we'll connect you with your local sales rep.
Store Information
Store Name *
Tax ID Number *
Is your store in the U.S.? *
Is your store online only? *
Untitled Title
Street Address *
City *
State/Province/Region *
ZIP/Postal Code *
Country *
Phone Number *
Additional Store Locations
Billing Information
Full Name *
Billing Phone Number *
Company *
Billing Street Address *
Billing Suite
Billing City *
Billing State/Province/Region *
Billing ZIP/Postal Code *
Billing Country *
Additional Info
Store Contact Name *
Store Contact Email *
How did you hear about us?
Clear selection
Submit
Never submit passwords through Google Forms.
This form was created inside of Paddywax. Report Abuse