Request A Wholesale Account

Please complete and submit the form below to request a customer account with Vermont Roots.

General Information

Company

First Name

Last Name

Type of Store

Federal EIN #

E-MAIL

Phone

Billing Address

Street 1

Street 2

City

State

Zip Code

Shipping/Delivery Address (If different from billing address)

Street 1

Street 2

City

State

Zip Code

Questions or Comments?

Validation

2 x 8 x 6 =