REQUEST A WHOLESALE ACCOUNT

If you are looking for our retail website, please go here. If you already have a wholesale account, login here.

* denotes required field.

Account Information

Company Name* "Doing Business As" (DBA) Name

Legal Business Name

Main Contact Person*

Title

Tax ID Number

Email Address*

Phone*

Mobile / Other Phone

FAX

Billing Address 1*

Billing Address 2

Billing City*

Billing State*

Billing Zip/Postal Code*

Billing Country*

Ship To Company Name / Attn* (35 chars max)

Ship To Contact Name* (35 chars max)

Shipping Address 1* (35 chars max)

Shipping Address 2 (35 chars max)

Shipping City* (30 chars max)

Shipping State*

Shipping Phone (15 chars max numbers only)

Shipping Zip/Postal Code*
(9 chars max, numbers & letters only)

Shipping Country*

The State of Indiana requires us to keep a General Sales Tax Exemption Certificate (ST-105) on file for wholesale accounts.
Please fill out the form (Form_105_Indiana_General_ Sales_Tax_Exemption_Certificate.pdf) and send, as a PDF, to info@terraspice.com