Wholesale Account Registration

Contact Information

Business Name

Individual Contact Name(s)*

Please select appropriate role.

Telephone #*

Cell #

Email*

Federal ID Number, if applicable.

Please provide Federal ID number, if you have one. This is NOT a social security number.

Website

Social Media Links

How did you hear about FiberArt and/or Pure Country? What is your vision for your woven tapestry?*

Shipping Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Billing Address

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred Shipping

UPS Account #

FedEx Account #

Art Name

Art Description

Notes

The information I provided is true and correct.

Name

This field is for validation purposes and should be left unchanged.