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Wholesale Account Application

Provide us with some information about your company, and we'll send you a sample of each type of cushion for you to sit on and consider the options.

Company Information: Company Name:

Address:

City:

State/Province:

Country:

Zip/Postal Code:

Phone Number:

Email:

Website:

Business Information: Type of Business:

Years in Business:

Sales Tax ID Number:

Number of Employees:

Primary Contact Information: First Name:

Last Name:

Title:

Phone Number:

Email:

Billing Contact Information (if different from Primary Contact): First Name:

Last Name:

Title:

Phone Number:

Email:

Shipping Information (if different from Company Address): Address:

City:

State/Province:

Country:

Zip/Postal Code:

Product Information: Please list the products you are interested in purchasing and the quantity you expect to order:

Additional Information: Please provide any additional information about your business or order that you think would be helpful:

Agreement:

By submitting this application, you agree to our terms and conditions and certify that the information provided is accurate and complete to the best of your knowledge.

Signature:

Date: