Email*
Store Name*
https://vendor.ecomilli.com/store/[your_store]
Store Phone*
Do you own a business?
(If No) Do you have permit to do business in the USA
What is your business type?
Business Name, used to register with your state or federal government (Business name as it appears on business registration document)
I confirm my business location and type are correct, and I understand that this information cannot be changed later.
Business EIN (Employer Identification Number)
Company registration number
Registered Business Address
The person who is filling out this form is -
Name of the owner/representative of the business
Country of Citizenship
Country of Birth
Date of Birth
Name (Driving License)
ID Number (Driving License)
Date of Issue (Driving License)
Date of Expiry (Driving License)
Country of Issue (Driving License)
State of Issue (Driving License)
Proof of Identity. Please upload your Drivers license or any state issued photo identity
Name of the Bank
Bank Account Number
Re-enter Bank Account Number
Name Registered with bank account (The name you select should match with the name associated with the bank account)
Digit Routing Number (Federal ABA Number)
Re-enter Routing Number
Store Name
Do you have Universal Product Codes (UPCs) for all your products?
Do you have a CSV file of all of your products?
How do you best describe your products and business
Do you have any diversity certifications (e.g. Minority, Women, Veteran, or LGBT-owned business) that you wish to add to your account?
Name of the primary contact person
Email address to contact
Password*
Confirm Password*
*
Agree Terms & Conditions
