Golden Poppy Wholesale Account Application
Thank you for your interest in Golden Poppy's Wholesale Program!

Please complete the following application. Your information will be reviewed and responded to as soon as possible.

If you have any problems or questions regarding this form or qualification, please email our Team: goldenpoppyherbs@gmail.com

Email address *
Date *
MM
/
DD
/
YYYY
Business Name *
Your answer
Contact Person First & Last name *
Your answer
Contact Phone Number *
Your answer
Business Website: *
Your answer
Business Address *
Street, City, State, Zipcode
Your answer
What kind of business are you? *
Tell us about your business
Your answer
How do you plan to use/sell our products? *
Online? In a store/studio? In your office? In your products?
Your answer
Tax ID Number *
Your answer
Sales Tax License Number *
Your answer
By typing in your name below you agree to the Wholesale Agreement outlined at https://www.goldenpoppyherbs.com/wholesale *I have reviewed and understand the Golden Poppy wholesale agreement listed above for all terms and conditions. I authorize Golden Poppy to keep this agreement on file and apply these policies to all future transactions. * *
Your answer
Anything else?
Your answer
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