Mr. Pen Retailer Application

Name
First Last
Phone
Email*
Role
Company Name*
Company Phone Number*
Store Type*
Where would you like to sell our product? Please note that we do not allow partners to resell our items online at the moment.
- eCommerce
- Brick and Mortar Location
- Both
- Other
Website
Do you have a reseller permit?
- Yes
- No
Shipping Account #
If you would like us to bill your business shipping account-if not leave blank.
Shipping Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Where the product would be shipped-not a P.O. Box.
Years Business Started
Number of Store Locations
Message*