New Account Application

Account Information

Store Name*

DBA*

Buyer*

Email*

Website

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Mobile

Fax

Accounts Payable Contact Name*

First Last

Email*

Same as store address?*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred Terms*

Note: Final terms to be reviewed and approved by credit team

Store Name*

Same as store address?*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Years in Business*

Store Square Footage*

Brands Carried*

List Additional Locations

Target Market: (Age, Gender, Etc)*

Categories Carried:*

Markets Attended:

Interested in Selling bobi Products Online?*

Sales Rep*

Upload Image of Your Store

Name

This field is for validation purposes and should be left unchanged.