TuckerWraps Wholesale Registration

If you would like to wholesale TuckerWraps in your store or online store, then please complete the fields below to register to the TuckerWraps program.

Please note that all stores doing business in Washington State must provide a State Reseller Certificate. Please fax a copy to TuckerWraps at 1 425 369 0201.

Store Details
Store Name:
Legal Name:
Agent Name:
Web Address:
Type of Business
Type of Business
Sell Online?	Yes    No
Require drop- shipping ?	Yes    No
Address Details
Shipping Address:
City:
State:	Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming
Zip Code:
Billing Address:	As Above
City:
State:	Select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington D.C. West Virginia Wisconsin Wyoming
Zip Code:
Contact Details
Primary Contact:
Account Contact:
Phone:
Fax:
Email:
Other Information
Other Comments:

Please note that you may also print and fax this form to us at 1 425 369 0201.