Create Wholesale Account

Ship To: same as billing

Business Title:

First Name:

Last Name:

Email Address:

Phone Number:

Fax Number:

Company:

Address:

Address 2:

City:

State/Province:

Other State/Province:

Zip/Postal Code:

Country:

Bill To: same as shipping

Business Title:

First Name:

Last Name:

Email Address:

Phone Number:

Fax Number:

Company:

Address:

Address 2:

City:

State/Province:

Other State/Province:

Zip/Postal Code:

Country:

Additional Customer Information

Kheops Customer Number: This number will be assigned when your account is approved.

Valid Resale Tax #:

Federal ID # (EIN): (For AK, DE, MT, NH, OR only)

Store Open since or (Store Opening):

Do you own a Internet Business ? https://:

Your Alternate phone number:

Type of Business?:

How did you find us?:

Do you have a Brick and Mortar store?:

Would you like to be contacted by an Account Executive?:

Tax document:

Allowed file types:
gif, jpeg, jpg, png, and pdf
File size can not exceed 10 MB.

I agree to the Terms and Conditions

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