Wholesale Account Application Form Application Date * MM DD YYYY Business Name * Business EIN/Tax ID * Form of Entity * Corporation Limited Liability Company Partnership Sole Proprietorship Other Sales Tax Exempt Yes Sales Tax License Number Business Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Contact Name * First Name Last Name Contact Number * (###) ### #### Work Email * Notes and Questions Thank you! Please also send us your sales tax certification if you are sales tax exempt for wholesale orders to the following email address: business@longite.com