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Business Name

Username

First Name

Business Address

Last Name

Contact Person Title

Contact Person Email

Mobile Number

Business Address

Business Website Address

Address 2

City

State

Zipcode

Business Description

Primary Business Focus

Physical store that customers visit to make purchasesCustomers purchase through an E-commerce website

Headquarters Address

Headquarters Address 2

Number of Locations

City

State

Zipcode

Tax ID Number

Federal Business ID Number

A Federal Business ID Number is required when you are unable to provide a Tax ID numbe

How did you hear about us?

Buffalo Distro WebsiteOnline Advertising

Friend / FamilyOther*

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Business LicenseReseller Tax ID

Federal Tax ID/EIN

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