Retailer Application

Please fill out the following application if you'd like to be reviewed to become a retailer partner.

Copies of your federal tax ID and resale tax ID must be faxed with your first order. Please take a few minutes and fill out this online application.  You will be notified once you are approved. 

If you have any questions regarding the status of your application, please contact sales@getjackblack.com.

* First Name:   * Last Name:  
Title:
* Store Name:  
Application Type
* Federal Tax ID#:   * Resale Tax ID#:  
All new U.S. accounts must have a federal tax ID and Resale tax ID to open a new account.
If you do not have one of the above, type N/A and explain why in the section below:
* Email:     * Confirm Email:    
Website URL:
* Phone #:     Fax #:  
Mailing Address
* Street Address:  
* City:   * State/Province:  
* Zip/Postal Code:   * Country:  
Store Address
* Street Address:  
* City:   * State/Province:  
* Zip/Postal Code:   * Country:  
* Type of Retailer:  
* Specialty:       
* Price Range of Merchandise:  
Describe your store
* Location:  
* Clientele:  
* Décor:  
* Size (sqft or sqm):  
Please upload 2 images of your store as JPEG files (no larger than 2MB). Please include an image of the front of the store and the space where you would merchandise Jack Black
  Image 1       Image 2
Other Details:  
The more you can describe your store in detail, the better it will assist us in approving your wholesale status.
* Is your store currently open?   * If yes, how many years has it been established?  

* How many (brick & mortar) store locations do you have?
Name 3 brands that you carry or plan to carry.
* Brand 1:  
* Brand 2:  
* Brand 3:  
* Other Brands:
How did you hear about us?







Comments or Questions:
 

Jack Black products may not be sold on the internet without prior written approval. Retailers may not offer Jack Black products on any other third party websites, including bidding or auction style sites, regardless of whether a bid pricing formula or fixed pricing formula is used.