Application

Company Details

Legal Business Name *

Doing Business As (DBA) *

Shipping Address*

Address Line 1

City

State

Zip Code

Billing address same as shipping address?*

Yes
No

What category best describes your business?

Website

Contact Details

Name *

First

Last

Email *

Phone

Uploads

Government Issued ID

Click or drag a file to this area to upload.

Employer Identification Number (EIN)*

Click or drag a file to this area to upload.

File Upload

Click or drag a file to this area to upload.

Form W-9*

Click or drag a file to this area to upload.

Download form here

Resale Certificate (Texas companies only)

Click or drag a file to this area to upload.

Download prefilled form here

Signature

Phone