Wholesale Program Fillable Application .pdf

wholesale CUSTOMER

APPLICATION
contact name:

A wholesale license or sales tax certificate along with our
Wholesale Customer Application must be submitted
and approved before a client will be able to purchase
our services at wholesale rates.

contact email address:
legal business name:

trade name (d.b.a. if applicable):

business owner(s) name(s):
federal i.d. number:

state of incorporation:

web address:
billing address:
briefly describe your primary customer type and product line:

..
.

By submitting this application and affixing my signature below, I certify the following:
I understand that wholesale rates are confidential and will not be shared with any other party.
If I am a resident of Indiana or Illinois, I understand that I am only entitled to a sales tax exemption for items that I will be reselling.
I will notify Jupiter and Juno/Just Invite Me if I am ordering a product that will not be resold.
Payment in full is required before any services will be rendered or products will be shipped.

owner signature:

date:

By signing this application electronically, I certify under penalty of perjury that my answers are correct and complete to the best of my knowledge.