Retailer Application

Your Information

Full Name (required)

Email Address (required)

Phone Number (required)

Business Information

Resale Tax ID (required)

Website (required)

Facebook (required)

Instagram (required)

Store or Business Address (required)

Briefly describe your store and the types of products/services you offer.

Tell us about your needs.

Which Brown & Coconut products are you interested in carrying?

When are you hoping to have the products in-stock?

How did you hear about Brown & Coconut?

Any other information you would like to include?