- Wholesaler Registration Form

Thank you for your interest in becoming a Loungefly wholesaler. Please complete the below application and submit for review. Applications will be reviewed and a representative will contact you if you have been approved. Please allow up to 7 days for a response. Because of the number of requests applications with missing information will not be processed. We look forward to working with you soon!


	First Name: *
	Last Name: *
	Business Name: *
	Bill to Address 1:
	Bill to Address 2:
	Bill to City: *
	Bill to State: *
	Bill to Zip Code: *

	Shipping address (leave blank if same as bill to or mark multiple if more than one)
	Ship to Address Name: *
	Ship to Address 1:
	Ship to Address 2:
	Ship to City: *
	Ship to State: *
	Ship to Zip Code: *

	Country (outside US)
	Email Address: *
	Phone: *
	Fax:
	Resale/Tax ID: *
	Type of Business: *

	Number of Locations: *
	Online store web address:
	Years in Business: *
	Lines Carried: *
	Do you ship internationally?