Retailer Registration Customer Account ID * Company Name * DBA * Full Name * Phone Number * Fax Number * Email Address * Website * Resale Tax ID * Upload Proof Of Resale Tax ID Here (MAX 2MB) * Tax ID Number * Upload Proof Of Tax ID Here (MAX 2MB) * Business Address * Retailer with Store Front *YesNo Online Retailer *YesNo Other (Please Specify) Message