Business Opportunity
If you have an inquiry about Wholesale Program, please fill in this form.
Other inquiries, please send your message to the e-mail address below.
Email: cs@patchworksonline.com
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Name of business*
Name of business*
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First Name*
First Name*
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Last Name*
Last Name*
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Email*
Email*
This will be your account login ID
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Phone Number
Phone Number
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Shipping Address*
Shipping Address*
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Apartment, Suite, etc.*
Apartment, Suite, etc.*
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State*
State*
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City*
City*
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Zip Code*
Zip Code*
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Country*
Country*
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Business Main Address
Business Main Address
*If different from shipping address
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Form of business*
Form of business*
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Other (Specify)
Other (Specify)
*if you selected "Other" from above
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Owner's Name
Owner's Name
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EX-
EX-
Exempt Organization Sales tax Certificate#
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Tax Resale#
Tax Resale#
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Tax ID#
Tax ID#
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Physical Store Address*
Physical Store Address*
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Physical Store Email
Physical Store Email
If different from above email address
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Phone Number
Phone Number
If different from above phone number
Please upload Signed Agreement and Copy of Seller's Permit.
Files must be under 3mb.
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Message
Message
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Password*
Password*
This will be your account login password