Wholesale Partners – Pure Country Weavers

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Wholesale Registration

First Name

Last Name

Business Name

Business Email

Business Phone

Business Type

NUMBER OF LOCATIONS

Number of Locations

NO SALES to online Marketplaces such as Amazon, Etsy, eBay, Wayfair, Walmart, Jet, Overstock and Houze etc. *

I Understand I Understand * required

Date Signed * required

Individual Contact Name

Federal ID Number

Your Position in the Company Owner: Sales: Business Rep: Other:

How did you hear about Pure Country Weavers

Billing Address

Billing Address Continued

Billing City

Billing State or Province

Billing Zipcode

Billing Country

Shipping Address

Shipping Address Continued

Shipping City

Shipping State or Province

Shipping Zipcode

Shipping Country