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WHOLESALE
REGISTRATION
BUSINESS INFORMATION
Company
*
Legal Business Name (use Company name shown on your official business documents)
*
Doing Business As (DBA)
Business Identifier Type
*
EIN
Business ID
VAT
Other
Business Identifier
*
Reseller Tax ID
*
First Name
*
Last Name
*
Phone Number
*
Email
*
Website
BUSINESS TYPE
Restaurant
Grocery Store
Online Store
Farm Store
Other Business Type
How many years have you been in business?
*
Legal Type of Business?
*
Sole Proprietorship
Partnership
Limited Liability
Corporation
Other (please explain)
Quantity of physical locations?
*
BILLING ADDRESS
Billing Address Line 1
*
Billing Address Line 2
Billing City
*
Billing State
*
AL
AK
AZ
AR
AS
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
TT
UT
VT
VA
VI
WA
WV
WI
WY
Billing Zip
*
SHIPPING ADDRESS
Billing Address same as Shipping Address
Shipping Address Line 1
Shipping Address Line 2
Shipping City
Shipping State
AL
AK
AZ
AR
AS
CA
CO
CT
DE
DC
FL
GA
GU
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
MP
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
TT
UT
VT
VA
VI
WA
WV
WI
WY
Shipping Zip
CURRENTLY PURCHASING
Fresh
Processed
Dried
Freeze-Dried
Fruit
Honey
Vegetables
Beef
Herbs
Goat
Flowers
Chicken
Chicken Eggs
Other interests
Average Monthly Volume
Purchase Frequency
Typical Fulfillment Method
Pick-up
Local Delivery
UPS 2nd Day Air
UPS 1st Day Air
What would you like samples of
AGREEMENT
Terms Agreement
*
By submitting and creating this Wholesale business account, you agree to the Nutrient Farm terms and conditions and privacy policy linked below in the footer.
SUBMIT
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