Wholesale Application

In order to purchase selected Brothers Broadleaf product wholesale, fill out the form below and supply requested documents.

After we verify your information (usually within 2-3 business days) you will receive a welcome email with wholesale login information. Wholesale accounts will not be attached to any personal account you may have and can not use the same email associated with any current open accounts.

Name of Business (DBA) *

Name of Person Responsible for Purchasing *

First

Last

Email to be used for the Account *

This email address cannot be already set up with a personal account, if the email is already set up then the personal account will be deleted so that the wholesale account can be created.

Contact Phone Number of Purchaser *

Store Phone Number *

Business Information

Street Address of Store *

Unit Number

City *

State *

Zip Code *

FEIN *