Wholesale Account Application
CONTACT INFORMATION
Wholesale Business License Number (Seller Permit, or EORI#, or CBN#, or ABN#, or VAT#, or business license)
Business Document UploadIf physical store, please load an image of store front
Business NameStore Name/Website (Mandatory for web-based businesses)
Contact Name
LastFirst
Billing Address
Address Line 1 Address Line 2
CityState Zip CodeCountry
TelephoneFax
Email (A verification email will be sent to this email address. In order for Pleaser USA to receive your form, you must confirm the verification email.)
Shipping Address (If different from above)
Address Line 1 Address Line 2
CityState Zip CodeCountry
STORE / BUSINESS TYPE
Store Type:
Physical StoreBoutique
Chain stores
Seasonal
Pole Studio
Boutique/Ecom
Discount
EcomDom Drop Ship-Own Website
Dom Drop Ship-Market Places
Inventory-Own Website
Inventory-Market Place
Int’l Special Order-Own Website
Int’l Special Order-Market Place
Presale-pickup or UPS/Fed packaging service
Mobile SalesEvents/Popups
Clubs
Home Party
WholesalerMail Order/Catalog
Brand Type:
PleaserALL
Clubwear
Romance/Couples
Fetish
Pole Fitness
Pink Label Extended Size
Single Sole
DemoniaALL
Classic Goth
Young Goth
FuntasmaALL
Sexy Costume
Traditional Costume
Victorian
Medieval/Pirate
Cosplay
Pinup CoutureALL
Vintage
Rockabilly
FabuliciousALL
Pageantry/Bridal/Prom
Fitness Competition
DeviousALL
BordelloALL
Current Supplier(s)
HOW DID YOU HEAR ABOUT US?
Existing Customer Referral(Specify): 
Demoniacult referral
LA Showroom
Mailing List
Other(Specify): 
Outside Sales Rep(Name): 
Pleaser Shoes Referral
Search Engine(Specify): 
Tradeshow(Specify): 
Word of Mouth

All fields must be completed. Missing information may result in cancellation of request.
A copy of resale license is required for domestic and international customers; a copy of CBN is required for Canadian customers.
 
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