Registration for Buyer's Account

Apricot Hills, quality homemade soaps and lotion bars

4389 Palmer Rd NE; New Lexington, OH 43764 - (740) 342-5454

WHOLESALE BUYER ACCOUNT (WBA) REGISTRATION

To purchase at wholesale prices, you must register. A Sales & Use Exemptions Certificate is required. Upon completion of this registration,

a confirmation page will display. Print it for your records as it gives your user name, access code (password), and ordering instructions.

VENDOR INFORMATION

HINT: Use the [TAB] key to go from field to field. DO NOT hit the [ENTER] key until you are ready to submit form.

Billing Address & Contact Info
Provide the billing information for your company. Items in RED are required entries.

Name	*Title*
Company
Address
*City*	*State*	*Zip*
Phone	Phone
*Cell*	*Fax*
eMail	*Other*

Shipping Address & Contact Info (if different from above)
Provide the shipping information and name of person responsible for orders/ordering, only if different from billing info.

Name	*Title*
Company
Address
*City*	*State*	*Zip*
Phone	Phone
*Cell*	*Fax*
eMail	*Other*

Special Instructions

Examples: "Always mark packages Attention John" -or- "Account Information Update"

How did you hear about Apricot Hills?
This information is appreciated.

Vendor's License Number and/or Sales Tax Exemption Info (REQUIRED)

Choose a User Name (REQUIRED)

Your User Name may be between 6 and 10 characters long. An Access ID (password) will be provided on the Confirmation page.

'Signature' - name of person filling out this form (REQUIRED)

By clicking the [Submit Registration] button below, I state that I am, or have been authorized by, the person responsible for purchasing wholesale items for the above named company.

Please wait, it make take up to 30 seconds depending on your connection speed.

end of form

Your company or personal information will never be sold nor shared with anyone outside of Apricot Hills.

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Apricot Hills - 4389 Palmer Rd NE; New Lexington, OH 43764 - Phone 740 342-5454

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