Owner *

First Name

Last Name

Buyer

(If different than owner)

First Name

Last Name

Business Phone *

(###)

###

####

Physical Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Shipping Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I AGREE:

By submitting this application, I certify that all information on this application is accurate and true to the best of my knowledge. In addition, I acknowledge and understand that the wholesale agreement is strictly offered to customers intended to resell SaintRomain Textile products, and we reserve the right to reject this application or terminate it at any time. This application does NOT grant credit terms.

Yes

No