Wholesale Partner Application

Business Name *

DBA (If Applicable)

Business Type

Retail Store Online Retailer Distributor Janitorial Supply Health & Wellness Retailer Commercial Cleaning Company Other:

Website

Billing Address

Shipping Address

Please tell us about your business

How do you plan to market or sell Culleoka Company products?

Estimated First Order Volume

$250–$1,100 $1,101–$1,800 $1,801+

I certify that all information provided in this application is accurate and complete. I understand that approval into the Culleoka Company Wholesale Partner Program is subject to review and acceptance by Culleoka Company.

Wholesale Partner Application

Business Information

Primary Contact

Billing Information

Shipping Information

Business Profile

Wholesale Program Acknowledgement