Commercial Account Application

Your business may qualify for below wholesale pricing. Complete the application below or call 913-708-1985.

This Form cannot be submitted until the missing fields (labelled below in red) have been filled in
Please note that all fields followed by an asterisk must be filled in.
Name of Business*
Description of Business *
Type of Business*	Sole Proprietor Partnership Corporation Other (please describe)
If other, description of type of business
Do you advertise?	Yes No
First Name*
Last Name*
E-Mail Address*
Web Site URL
Street Address*
City*
State/Prov*
Zip/Postal Code*
Home Phone*
Business Phone
Fax
Shipping Street Address*
Shipping Street Address Line 2
Shipping City*
Shipping State*
Shipping Zip Code*
I am submitting an application for a Commercial Account which would give me below wholesale pricing. If I am approved for a Commercial Account, I understand that the products are strictly for use in my business and not to resell to other parties.	I agree I do not agree
Please enter the word that you see below.