Approval-Only Entry

Retailer Onboarding Engine

This form creates a pending application only. It does not create an active buying account.

First Name *

Last Name *

Title *

Business Email *

Phone *

Exact Legal Entity Name *

DBA *

Website URL *

Monthly Buying Volume *

Billing Address *

Shipping Address *

Federal Tax ID / EIN *

State of Incorporation *

Resale Certificate No. *

Upload Resale Certificate PDF/JPG/PNG Max 5MB *

Independent Grocery

E-commerce

Logistics / 3PL

Omnichannel

Other

Notes *