New Wholesale Request Form

New Wholesale Retailer Request Form
Would you like to carry Heidi's Raspberry Farm products in you shop? Let us know more about you and your business! Please allow 5 - 7 business days for requests to be reviewed.
Name of Business
Main Contact Info
First NameLast Name
Billing Address
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Shipping Address (if other than billing)
Street Address
Street Address Line 2
CityState / Province
Postal / Zip Code
Phone Number
Format: (000) 000-0000.
E-mail
Website
i.e. www.heidisraspberryfarm.com
Tell us a little bit about your business
A brief description of your business (what types of products you sell, customer base, etc).
How did you hear about Heidi's?
Payment Options
Heidi's prefers to take payment via Quickbooks ACH (via invoice) or check.
If you are interested in 15+ day terms we require one (1) bank reference and two (2) trade references.
Business Tax ID #
If applicable
References for terms
One bank reference, two trade references
Should be Empty:

New Wholesale Retailer Request Form