Wholesale Account Application

ACCOUNT SETUP

Contact, shipping, and billing information
Hi there! In order to get you setup for orders of any size, we'll need a little information from you so we can introduce you to our team and get you setup with your online ordering credentials. Questions about the form or your next steps with Revelator Coffee may be directed to your wholesale representative, or wholesale_orders@revelatorcoffee.com.

Revelator Coffee Company | 337 Elizabeth St NE, Suite B, Atlanta, GA 30307
TODAY'S DATE:*

MonthDayYear
BUSINESS INFORMATION
COMPANY NAME:*
TAX ID #*
OWNER / MANAGER:*

First NameLast Name
EMAIL:*
PHONE:*

Area CodePhone Number
NOTE/S FOR REVELATOR (Launch Date, Special Needs, Requests, etc):
SHIPPING INFORMATION
ATTN:

First NameLast Name
SHIPPING ADDRESS:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
PAYMENT

Our accounting manager may be reached at ap@revelatorcoffee.com. Please provide your team's accounting contact and billing preferences below:
ACCOUNTS PAYABLE CONTACT:*

First NameLast Name
AP EMAIL:*
AP PHONE:*

Area CodePhone Number
PREFERRED PAYMENT METHOD:*

CHECKCREDIT
Should be Empty:

ACCOUNT SETUP