Wholesale Form – Intellius Group

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123 Main Street, New York, NY 10001

123-456-7890

Home
Shop
Special Offers
Clearance
Pallet Deals
Wholesale Form
FAQ’S
About Us
Contact US

Home
Shop
Special Offers
Clearance
Pallet Deals
Wholesale Form
FAQ’S
About Us
Contact US

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Contact Verification

Email Address *

Phone Number *

Business Information

Registered Company Name *

Doing Business As (DBA)

Contact Name *

WhatsApp Number *

Country of Registration *

Company Registered Address *

Shipping Address *

Business Type & Operations

Type of Business *

Online Seller
Retail Store
Wholesaler
Distributor
Importer/Exporter
Brand Owner/Manufacturer
Prep Center/3PL
Agency/Account Manager
Other

Single Line Text

Doing & Type

Estimated Monthly Purchasing Volume (USD) *

Under $5,000
$5,000–$25,000
$25,000–$100,000
$100,000–$250,000
Over $250,000

Years in Business *

Sales Channels

Where do you sell? (Multi Select) *

Online Store
Physical Retail Store
Wholesale
Amazon
Walmart
eBay
TikTok Shop
Shopify
Etsy
Target Plus
Faire
Shopee
Lazada
Noon
Flipkart
Facebook Marketplace
Instagram Shop
Other

Single Line Text

Storefront Link / Seller ID *

Website Link *

Shipping Preferences

Shipping Destination Type

Own Warehouse / Business Address
Marketplace Fulfillment Center

Legal Business Documents

USA businesses must upload a Seller's Permit or Resale Certificate, Other countries should upload the Equivalent Required Business Document.
Supported formats: PDF, JPG, PNG. Minimum one document is required. *

File Upload *

Drag & Drop Files, Choose Files to Upload

Declarations & Compliance

Checkbox Items *

I hereby confirm that all information, documents, and representations submitted are accurate, complete, and authentic.
I hereby acknowledge and agree to comply with all policies of Affirma Distributors.
I understand that Affirma Distributors reserves the right to request additional verification, documentation, or clarification at its sole discretion.
I authorize Affirma Distributors to verify submitted information, including contacting references, suppliers, or third parties, without prior notice if required.

Additional Comments

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Date

Customer Care
INTELLIOS GROUP

Email: Wholesale@affirmadistributors.us
Direct Line: +1 516 244 3318
What’s App: +1 (518) 941-0723
Monday–Friday, 9 AM–5 PM (EST)

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