Moby™ Wrap Baby Carriers : Merchant Application
 
Moby Wrap,Inc.  
 
 
                   
 

Moby™ Wrap Merchant Application
Company Name*
Contact Name*
Shipping Address*
Shipping Address2
City*
State*
Zip*
Country*
Phone Number*
eg.(333)555-9999
Toll Free Number
Cell Phone Number
Fax Number
Email Address*
Website Address
eg. http://www.mobywrap.com
Resale Permit Number*
Type of Business* Distributor
Storefront
Website
Person to Person
Company Information
Username*
Password*
Confirm Password*
* indicates required field
Wholesale payment information :
   wholesale accounts may pay by credit card or PayPal®.

     For PayPal payment :
PayPal email account :
           We will send you a "payment request" just before shipping your order.

     For credit card payments : Please print, complete and fax the credit card authorization form.

Would you like a new merchant package sent to you via snail mail ? Yes No
(The package includes fabric samples, wholesale price list and paper versions of the merchant application,
credit card authorization and order form.)

 
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