Account Request Form
Please use this form to send us the information we require to set up your wholesale account.
Email address *
Contact Information
The information in this section if for the individual who will be the account contact and responsible for the account.
Contact Full Name *
This should be the name of the person who will be the account contact.
Your answer
E-mail Address *
This will be used as the main email used for communication with the contact. Passwords, usernames, invoices and other sensitive information will be sent to this email address.
Your answer
Direct Phone Number
This field is not required but may prove useful one day. We will always contact the business phone first.
Your answer
Company Informtion
Business Name *
Your answer
Street Address *
Your answer
Your answer
City *
Your answer
State *
Please use the two-letter abbreviation.
Your answer
Zip Code *
Your answer
Country *
Your answer
Business Phone Number *
Your answer
Your answer
Type of Business *
Please select the option that most closely describes your business.
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This form was created inside of Stretch Logic LLC.