( * = Required)

Account Info


Your Email *

Re-type your Email *

Your Password *
Password must be at least 7 characters long

Confirm Password *



Business and Identity Information


Company Name *

Types of Goods Sold *

Website

Federal Tax ID *

Business and Identity Verification Information - PLEASE READ
In order to verify your account, we will to see a valid seller's permit as well as a valid form of personal identification for the account holder ( U.S. Driver's license, U.S. Identification card, or Passport ). You may scan the images or use a clear photo from a digital camera or smartphone. Please know- that your privacy is our top priority. The images submitted via this form are never stored online.

Valid Seller's Permit *

Seller's Permit # *



Contact


First Name *

Last Name *

Title *

Phone *

Billing Email *



Billing Address


Address Line 1 *

Address Line 2

City *

Country *

State *

Zip Code *

Use the billing address for shipping?


Shipping Address


Address Line 1 *

Address Line 2

City *

Country *

State *

Zip Code *



Terms & Conditions


I agree to the Wholesale Buyer Account Terms & ConditionsI hereby certify that I hold a valid seller's permit. Issued pursuant to the Sales and Use Tax Law; that I am engaged in the business of selling the goods stated above; That the tangible personal property described herein which I shall purchase from: Robert Siegel Studio, robertsiegelstudio.com, will be resold by me in the form of tangible personal property; PROVIDED how-ever, that in the event any of such property is used for any purpose other than retention, demonstration, or display while holding it for sale in regular course of business, it is understood that I am required by the Sales and Use Tax Law to report and pay for the tax, measured by the purchase price of such property.