Wholesaler Signup

Thank you for your interest in TXLC. Please fill out the following wholesaler information.

* Indicates Required Field

General Information
Store/Business Name:*
Resale ID Number:*
Buyer First Name:*
Buyer Last Name:*
Mailing Address:*
City:*
State:*
Zip:*
Shipping Information (fill in if different from mailing address)
Address:
City:
State:
Zip:
Additional Information
Email Address:*
Phone Number:*
Additional Phone Number:
Fax Number:
What Products Are You Interested In?*
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How Did You Hear About Us?
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