Name *

First Name

Last Name

Phone *

(###)

###

####

Type of document (*must check one): *

EIN

Business License

Sales Tax ID

Reseller Permit

Other

Business Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Check all that apply (*must check at least one): *

I have a brick & mortar retail location

I will be selling products online

I am a licensed E-bay.com merchant

Other

Inventory (*must check at least one): *

I will stock physical inventory at my location.

I will have orders dropshipped to my customers.

I plan to carry physical inventory & have orders dropshipped.

Disclaimer: *

"I have read and agree to the Terms of Service provided by Pure Supps INC. I also attest that I am applying on behalf of a registered business and am able to provide proof of business via official document from a Local City Government, State Department or the Federal Government."