Request A Wholesale Account Please complete and submit the form below to request a customer account with Vermont Roots. Unless otherwise indicated, all fields are required. General Information Company First Name Last Name E-mail Phone Federal EIN Type of Store —Please choose an option—Convenience Stores - NAICS 44512Department Stores - NAICS 45211Fish and Seafood Markets - NAICS 44522Florists - NAICS 45311Fruit and Vegetable Markets - NAICS 44523Full Service Restaurants - NAICS 7221Gift and Souvenir Stores - NAICS 45322Grocery Stores - NAICS 44511Hotels & Other Travel Accommodations - NAICS 7211Limited Service Restaurants - NAICS 7222Liquor Stores - NAICS 44531Mail Order and Catalog Stores - NAICS 45411Meat Markets - NAICS 44521Other Direct Selling Establishments - NAICS 45439Other General Merchandise Stores - NAICS 45299Other Health and Personal Care Stores - NAICS 44619Other Miscellaneous Retail Stores - NAICS 45399Other Specialty Food Markets - NAICS 44529Pet and Pet Supply Stores - NAICS 45391Pharmacy and Drug Stores - NAICS 44611Special Food Services and Catering - NAICS 7223Other Billing Address Street 1 Street 2 (Optional) City State —Please choose an option—ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Zip Code Shipping/Delivery Address (If different from billing address) Street 1 Street 2 City State —Please choose an option—ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Zip Code How did you hear about us? —Please choose an option—Friend / ColleagueTrade Show / ConferenceWeb AdvertisementEmail NewsletterDirect MailEditorial / News ArticleSearch EngineOther Questions or Comments (Optional)
