New Retailer Account Inquiry - Rainforest Distribution

Company Name (Legal name)(Required)

D/B/A

Federal Tax ID#(Required)

Company Type(Required)

Business Description(Required)

e.g. Grocery Store; Cafe, Bar or Restaurant; Online Retailer; Wholesale Distributor; School, University, Airport, Venue, Gov’t; Other

State of Formation(Required)

Date of Formation(Required)

Company Website URL

Primary Contact Name(Required)

First Last

Primary Contact Title(Required)

Primary Contact Phone(Required)

Primary Contact Email(Required)

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Shipping Address(Required)

Street Address Address Line 2 City State ZIP Code

Store Phone(Required)

Do you have a multiple retail locations?(Required)

Additional Shipping Address 1

Street Address Address Line 2 City State ZIP Code

Additional Store Phone 1

Additional Shipping Address 2

Street Address Address Line 2 City State ZIP Code

Additional Store Phone 2

Will you be requesting credit terms?(Required)

Accounting Contact Name(Required)

First Last

Accounting Phone(Required)

Accounting Fax(Required)

Accounting Email(Required)

Name

This field is for validation purposes and should be left unchanged.