Wholesale Application Form

Enter Name & Physical Address

First name (optional)

Last name *

Company

Full address *

Apartment, suite, etc. (optional)

City *

Country/Region *

Province/State/Region *

Postal code *

Email *

Phone *

Upload Supporting Documents

Government Issued ID *

The max file size is 10MB.

Please upload a file before submitting.

Driver's License *

The max file size is 10MB.

Please upload a file before submitting.

Vehicle Insurance Card *

The max file size is 10MB.

Please upload a file before submitting.

Vehicle Registration *

The max file size is 10MB.

Please upload a file before submitting.

By entering your phone number, uploading your documents and submitting this form, you consent to receive marketing text messages from Dalogs Distribution Inc at the number provided, including messages sent by autodialer. Consent is not a condition of any purchase. Message and data rates may apply. Message frequency varies. You can unsubscribe at any time by replying STOP or clicking the unsubscribe link (where available) in one of our messages. View our Privacy Policy https://dalogsdistribution.com/pages/privacy-policy and Terms of Service https://dalogsdistribution.com/pages/terms-of-service.

How would you like to be contacted? *

We use email and targeted online advertising to send you product and services updates, promotional offers and other marketing communications based on the information we collect about you, such as your email address, general location, and purchase and website browsing history.

We process your personal data as stated in our Privacy Policy https://dalogsdistribution.com/pages/privacy-policy. You may withdraw your consent or manage your preferences at any time by clicking the unsubscribe link at the bottom of any of our marketing emails, or by emailing us at [email protected]

Social Media Handle (Instagram, Facebook, Twitter, Etc.)

Please add at least one of your social media handles.

Write your favorite Social Media Page here

Anything else you'd like to share about you?

Order products

Order Total (The sum of all the prices of all the items in the order, taxes and discounts included.)

Contact information

Shipping address

Billing address