Wholesale Account Request

Company Name *

Primary Contact First Name *

Primary Contact Last Name *

Name of Company Owners *

Nature of Business *

Company Phone Number *

A/P Contact Name

A/P Email

A/P Phone

A/P Fax

Business License Number

Number of Years in Business

Business Website

What type of customers does your business plan to sell Chocolove to?

Direct to Consumer
Business to Business
Third Party Distribution

How do you plan to use Chocolove in your business?

Physical Store Only
Physical Store & Online Store
Online Store Only
Amazon Reseller / eCommerce Platform

Billing Address 1 *

Billing Address 2

Billing Phone Number

City *

State *

Zip *

First Name

Last Name

Company

Shipping Phone Number

Shipping Email Address

Shipping Address 1

Shipping Address 2

City

State

Zip

Email *

User Password *

Username *

Confirm Password *

Thank you for completing the Wholesale Account Request application. Our customer service team will review your application and reach out to you if they require any additional information.

We strive to respond with 24-48 hours. If you have not received a response within that time please email [email protected]

If your application is approved you will receive an automated notification along with your login credentials. You may need to log out and back in again in order for the changes to reflect.