Online Seller Sworn Declaration Form

Online Seller Sworn Declaration Form
Please complete this form to declare your status and details as an online seller. Your responses will be used for verification and compliance purposes.
Full Name
First NameLast Name
Business Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Business Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Business Registration Number
Type of Business
Online Selling Platforms Used
Other
Main Product Categories Sold
Years in Business
Signature
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Date of Declaration
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: