Application for NY Sahara Wholesale Account

Email address

Username

Wholesaler

Company Name

Company Website

Business Type

- Select a value -RetailWholesale

Contact Name

Telephone Number

Fax Number

Address

Street address

Street address line 2

City

State

- None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)CaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMicronesiaMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip code

Preferred Sales Representative

- None -SaeedAliLuisGulSohrabKawashDiana

Resale Permit Number

Resale Permit or EIN Certificate

Upload

Upload requirements

• One file only.
• 1 GB limit.
• Allowed types: pdf, png, gif, jpg, jpeg.

Image of Resale Permit or EIN Certificate

Upload

Upload image of Resale Permit Certificate or EIN Certificate
Upload requirements

• One file only.
• 1 GB limit.
• Allowed types: png, gif, jpg, jpeg.

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