Registration – Blue-Emu Wholesale Reseller

Interested in Becoming a Blue-Emu Wholesaler or Reseller?

Please download, fill out, and sign the Sales Tax Certificate of Exemption and W-9 forms below. Then, upload them with your application below.

Important

Only wholesale accounts with brick and mortar locations will be considered for approval.

Sales Tax Certificate of Exemption Form

W-9 Form

Registration Wholesale

Primary Contact Person

Please complete the primary contact's information.

First Name

Last Name

Title

Phone

Fax

Secondary Contact Person

If you have a secondary contact person, please complete their information below.

First Name

Last Name

Title

Phone

Fax

Billing Address

Please complete the business billing address information below.

Address Line 1

Address Line 2 (Optional)

City

State

Zip Code

Shipping Address

Shipping Address, if Different

Address Line 1

Address Line 2 (Optional)

City

State

Zip Code

Additional Information

Where Do You Plan to Sell Blue-Emu

In Store

Online

Only wholesale accounts with brick and mortar locations will be considered for approval.

Estimated Monthly Order Size (in cases)

Completed Sales Tax Exemption Form & Completed W-9 Form

Choose File

Wholesale

Interested in Becoming a Blue-Emu Wholesaler or Reseller?

Important

Company Information

Primary Contact Person

Secondary Contact Person

Billing Address

Shipping Address

Additional Information

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