Please remember the email address and password you enter, as that information will be required to
login as a wholesaler if your application is accepted.
Prefix:
*First Name:
*Last Name:
*Company:
*Address:
*City:
*State:
*Postal Code:
*Email Address:
*Phone:
*Fax:
We will be emailing your activation
notice to this email address.
Shipping Information
*Shipping Address is:
Residential
Commercial
Check here if Shipping Address is the
same as Company Address above.
*Company:
*Address:
*City:
*State:
*Postal Code:
Business Information
*Class of Business:
Proprietorship
Partnership
Corporation
*Corporation Name:
*State Resale Tax Number:
New Owner:
Check if yes.
Purchase Date:
Length of Time in Business:
years
*Business Year:
Seasonal
Year Round
*Type of Business:
Gourmet Food Store
Department Store
Baskets
Restaurant/Caterer
Gift Shop
Other:
Comments
Account Information
*Terms Requested:
Credit Card
Net 15
*Requested Password:
1-800-7-HAM-I-AM! (1-800-742-6426) Local 972-447-0440