Store Name*[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


Confirm Password*

* Agree  Terms & Conditions