FOR DISTRIBUTORS, WHOLESALERS & RETAILERS

If you are a Wholesaler, Distributor, or Retailer in the U.S.A. and are interested in our products, we invite you to apply for an account. Simply complete the merchant information form below. You will receive email confirmation of your account status and account information. If you have any questions about our pricing, please contact us at 714.881.5088 or email us at info@inoshstyle.com

For international distributors, wholesalers, & retailers not in the U.S.A., please contact us at info@inoshstyle.com

NOTE: We do not permit the sale of our items on Ebay or any other auction site.

All fields marked with an asterisk (*) are required.

	*First Name
	*Last Name
	*Company Name
	*Phone Number
	Fax Number
	*Email Address
	Billing Information
	*Address 1
	Address 2
	*City
	*State
	*Zip Code
	Shipping Information
	Address 1
	Address 2
	City
	State
	Zip Code
	Shipping Contact (if different from main contact)
	Phone Number
	Email Address
	Store Location same as shipping address?
	Company Information
	Fedex Tax ID
	*Resale Number
	*Type of Store
	*Type of Sales
	*Years in business
	*Tell us about your store
	*What other brands and products do you carry?
	Online Store Information
	If you operate an online store with shopping cart, provide URL
	Do you plan to sell INOSH Products on other websites? (if yes, please list all URLs, separate multiple URLs with comma)
	Brick and Mortar Store Information
	Number of brick and mortar stores
	If store location is different than shipping address, please provide store address and contact information (if you have more than one store location, please provide each address and contact information)
	Additional Information
	*How did you hear about INOSH & Konjacu?
	Comments