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New Wholesale Account Form

Store Name

Store Owner Name & Number

Buyer/ Contact

First Name

Last Name

Buyer Email Address

Buyer Phone Number

Billing Address

Shipping Address

What primary product category do you sell

Type of Retailer

Brick & Mortor

Franshise

Online Boutique

Hotel/Gift Shop

Other

Other Boutique Details/Considerations

TERMS: This is for legitimate wholesale use only. Full payment is due at time of shipping. Credit Cards (Amex, Visa, MC, Discover) are acceptable forms of payment. No cancellations, no refunds or credit on purchases will be granted without written authorization from P. Sherrod once order has been processed. Please print name and date below to agree to these terms.