Website Registration Form

Company Information

Subject*

COMPANY’S LEGAL NAME*

COMPANY’S DBA/TRADE NAMES (IF ANY)

COMPANY ADDRESS*

COMPANY ADDRESS 2

COMPANY ADDRESS CITY*

COMPANY ADDRESS STATE*

COMPANY ADDRESS ZIP CODE*

COMPANY EMAIL ADDRESS*

COMPANY PHONE*

ENTITY TYPE*

STATE OF INCORPORATION/ORGANIZATION*

EIN/TAX ID*

Primary Contact Information

FIRST NAME*

LAST NAME*

EMAIL ADDRESS*

PHONE*

Please note that consent to sell Products on online marketplaces is NOT granted through this website registration process.

1. PLEASE IDENTIFY THE URL FOR EACH WEBSITE WHERE YOU INTEND TO SELL PRODUCTS.*

2. DO YOU ALSO INTEND TO SELL PRODUCTS IN BRICK-AND-MORTAR RETAIL LOCATIONS?*

IF YES, PLEASE IDENTIFY THE PHYSICAL ADDRESSES FOR ALL BRICK-AND-MORTAR LOCATIONS WHERE YOU INTEND TO SELL PRODUCTS. IF NO, PLEASE ENTER N/A BELOW.*

3. FROM WHICH AUTHORIZED DISTRIBUTOR(S) DO YOU PURCHASE PRODUCTS?*

4. DO YOU INTEND TO STORE YOUR INVENTORY OF PRODUCTS AT A LOCATION OTHER THAN THE COMPANY ADDRESS IDENTIFIED ABOVE?*

IF YES, PLEASE PROVIDE THE ADDRESSES FOR ALL LOCATIONS WHERE YOUR INVENTORY WILL BE STORED. IF NO, PLEASE ENTER N/A BELOW.*

5. DO YOU INTEND TO USE ANY THIRD-PARTY FULFILLMENT SERVICE (INCLUDING DROP-SHIPMENT BY AN AUTHORIZED DISTRIBUTOR) TO FULFILL ORDERS FOR PRODUCTS PLACED THROUGH THE WEBSITE(S) IDENTIFIED IN QUESTION 1 ABOVE?*

IF YES, PLEASE IDENTIFY THE NAME OF THE FULFILLMENT SERVICE AND DESCRIBE THE SERVICES PROVIDED. IF NO, PLEASE ENTER N/A BELOW.*