OIA® Wholesale Retailer Form

We appreciate your interest in becoming a wholesale retailer of Only In Atlanta®. Please fill out the form below, and we will be in touch within 3-4 business days.

Company Name

Title/Role

Name

First Name

Last Name

Phone

(###)

###

####

Shipping Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Billing Address

(if different from shipping address)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Website

http://

Tax ID / Resale Number

Years in Business

Where are your products sold?

Type of Business?

Comments

I confirm that the information listed above is correct.

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