Wholesale Registration Form

*If your Tax ID is changed, it must be faxed to Tattered Angels. Thank You!

Personal Information
First Name:
Last Name:
Company Details
Company Name:
Owners Name;
Company’s Tax ID Number / Resale ID Number( (Required) Must be sent to us via internet or fax with your first order.
Website:
Shipping Address:
City:
State/Province:
Zip/Postal Code:
Country:		*
Billing Address:
What Kind of Store Are You?
Other:
Describe Your Store:
Your Contact Information
Phone Number:
Fax Number:
Comments:
Newsletter:
E-mail Address (note: this will also be your login):
Password:
Retype password: