Submission Form

The information you provide us below will set up an account for you to enter our wholesellers section of the site.

Please allow 24 hours for us to verify the information below and set up your account.

When you wish to submit an order, please login with your usr name and password you provide us to receive reseller prices.



1) Owner's First Name: 2) Owner's Last Name:
3) Company Name:
4) Company Address:
5) City:
:
7) Zip Code:
8) Phone #: - -
9) Your E-Mail Address:
(******NOTE******)
Below you will choose your user name and password. Please write them down.
10) Your User Name:
11) Your Password:
12) Your Resellers/Tax id#:
13) Where do you intend on selling:
14) Average Quantity per order:
15) $ Purchases/month:

Comments, Questions, Suggestions