Wholesale Price List and Shopping Area Request Form

Mandarava Wholesale
Wholesale Price List and Wholesale Shopping Area Login Request

P.O. Box 172, Lomita, CA 90717
www.mandarava.com/wholesale

Retailers: Please supply one of the following in the License field: Business License, Federal Taxpayer ID OR Federal EIN OR State Resale License. We ask for this information so that only legitimate Retailers have access to our wholesale information. Thanks for your cooperation. As soon as you have entered your information and pressed "Submit", you will immediately enter the Wholesale Shopping Area, where you may add wholesale items to your cart and shop Wholesale On-Line.
You will be emailed a user id (your email address) and a password that will allow you to re-enter the Wholesale Shopping Area whenever you wish.

First Name*	Last Name*

Company Name*	*Email: PLEASE TYPE CAREFULLY!**

Resale or Business Lic. Number*

Street Address	Additional Address Line (if req'd)

Apt. Num:	P.O. Box:

City:	State: Zip:

Country

Daytime Phone	Evening Phone

Comments

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