New Retailer Application – Elisabeth Everly & Co.

First of all, we thank you for your interest in partnering with us!

We love connecting quality products with specialty retailers and we look forward to working with you. We value your trust and will not share the information provided with any third parties.

Please fill out your information below and we will get back to you soon!

Store Name(Required)

Store Legal Name

Name(Required)

First Last

Email(Required)

Store Address(Required)

Address Address Line 2 City State ZIP Code

Shipping Address

Same as Store Address

Billing Address

Same as Store Address

Store Type(Required)

Traditional "brick and mortar" store

Online store (own website)

Catalog

Third party e-commerce

Other

Business Start Date(Required)

Owner Name

Owner Phone

Owner Email

Buyer Name

Buyer Phone

Buyer Email

A/P Contact

A/P Phone

A/P Email

Preferred Email for Order Copies

Website

Facebook

Instagram

First of all, we thank you for your interest in partnering with us!

copyright@ 2023 Elisabeth Everly & Co.