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.

Company Information

Company (Required)

Type of Business (Required)

Company Website

Tax ID (Required)

DUNS Number (If Applicable)

Primary Contact Person

First Name (Required)

Last Name (Required)

Title

Email (Required)

Phone (Required)

Fax

Secondary Contact Person

First Name

Last Name

Title

Email

Phone

Fax

Billing Address

Address, Line 1 (Required)

Address, Line 2

City (Required)

State (Required)

Zip (Required)

Shipping Address

Shipping Address, if Different

Address, Line 1 (Required)

Address, Line 2

City (Required)

State (Required)

Zip (Required)

Additional Information

Where Do You Plan To Sell Blue-Emu? (Required)
In StoreOnline
Estimated Monthly Order Size (Required)

Do you transmit orders using EDI?
YesNo
EDI Email Contact

Completed Sales Tax Exemption Form & Completed W-9 Form (Required)