Wholesale Andara Account Application

WHOLESALE ACCOUNT

Lady NellieTM
WHOLESALE ANDARA ACCOUNT APPLICATION

Initial minimum purchase: $150.00 (No minimum required on second purchase)

FULL NAME:

First Middle Initial Last

ADDRESS:

Street Address

City, State (Province) Zip Code

Country

Home Phone:

BUSINESS NAME:

the name you are doing business under

RESALE TAX ID:

BUSINESS ADDRESS: (if
different from above)

Street Address

City, State (Province) Zip Code

Country

Business Phone:

Internet Store

TYPE OF BUSINESS
Please check boxes that apply:

Website Address

Retail Store (Physical Store)

Email Address: