Wholesale Account Application

All potential new wholesale customer accounts must submit an Wholesale Account Application for proper review prior to approval. Once your wholesale account application is approved, we’ll contact you to approve our partner agreement and process your order. Thank you.

Company Name *

DBA

Business Type *

• Retail
• Online
• Catalog

Please check all that apply.

Ship to Address *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Billing Address (if different) *

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Business Phone Number *

Website / URL

Years in business? *

Resale or Tax ID# (No Dashes) *

How did you hear about The Ruby Slipper Swivel Car Seat Cover?

• Tradeshow
• Magazine
• Internet
• Social Media
• Referral
• Other

Please click all that apply.

Any other information you would like to share with us?

Payment Information

If you would like us to keep your credit card payment information on file, please fill out the fields below. Thank you

Credit Card VisaVisaMasterCardAmerican ExpressDiscover

Exp Date (M/Y)

Card number

SCC# on Card

Name on Card

Card Address

Address Line 1

Address Line 2

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Company Contact Information

Name *

First

Last

Title *

Email *

Phone *

Ext

By submitting this application you are agreeing to the Ruby Slipper Wholesale Terms & Conditions *

• I have read and agree to the Wholesale Terms & Conditions

Submit