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    New Retailer Form

    Store Name must match the name on the Resale Permit
    Please list the first and last names of all the personnel who are authorized to place orders on behalf of your store below.
    Use the e-mail address that you want to be used with communication from us.
    If different from the address on the Resale Permit please explain the discrepancy under comments.
    If "Other", please specify under comments what this is regarding to.
    Max file size: 20MB
    Please upload a copy of your Resale Permit.
Submit

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