Vendor Registration

Username*

Username*

Email*

Email*

First Name

First Name

Last Name

Last Name

Store Name*

Store Name*

https://staging.reefables.com/store/[your_store]

Address 1*

Address 1*

Address 2

Address 2

Country*

Country*-Select a location-United States (US)

City/Town

City/Town

State/County

State/County

Postcode/Zip*

Postcode/Zip*

Store Phone*

Store Phone*

Federal Tax ID Number (EIN)*

Federal Tax ID Number (EIN)*

State business license or sales tax/resale certificate*

State business license or sales tax/resale certificate*

Aquaculture License

Aquaculture License

Primary business activity*

Primary business activity*-Select-Brick and mortar retailOnline only retailAquarium maintenance & serviceWholesaleOther

Reference #1: Name and company*

Reference #1: Name and company*

Reference #1: Contact information*

Reference #1: Contact information*

Reference #2 (if necessary): Name and company

Reference #2 (if necessary): Name and company

Password*

Password*

Confirm Password*

Confirm Password*

* Agree  Terms & Conditions