Wiseman House Chocolates Wholesale Application

Wiseman House Chocolates Wholesale Application

Company Name * Enter your company name
Phone * Enter your phone number
Fax Enter your fax number
Web Site Enter your web site
Billing Address Enter your billing address
City Enter your city
State * Choose your state
Zip Code Enter your zip code
Shipping Address Enter your shippin address
City Enter your city
State Choose your state
Zip Code Enter your zip code
Date Business Commenced Enter the start date of your business (01/01/2003)
Sole ProprietorshipSole Proprietorship
PartnershipPartnership
CorporationCorporation
OtherOther
Locations list current locations of your store(s)
How Long at Current Address? List how many years or months at your current location
Own or Lease Premises Do you own or lease your property
Other Chocolate Brands Carried List all chocolate brands you carry
Contact Person Name of contact person
Title Title of the contact person
Phone Contact person phone number
Fax Contact person fax number
Email Contact person email

Type the following: For security purposes, please type the letters in the image.
By clicking the submit button, I acknowledge that I have read the Terms and Conditions of Sale and Directions for Care and Handling