In order to become a wholesaler, please fill out the following information.

We look forward to adding your store to our growing list of wholesalers selling our quality products.

Your Company Name:

Contact Name:

Reseller Federal Tax ID#:

State Sales Tax #

Year Store Opened: Years in Business:

Stores Name:

Website address:

Your E-mail address:

Stores Street Address:

Stores City: State: Zip:

Store Phone: Store Fax:

Describe your store (what you sell, brands you carry, etc.):

What kind of store is it? Online Only Brick & Mortar Only Brick & mortar + Online Non-Profit Auction (E-bay, etc.) Home Based

How did you hear about Nittany Valley Organics? Google Ad Google Search Yahoo Ad Yahoo Search Bing Search Other Search Customer on NVO Friend told me about you Other