Wholesale Dealer Application

To submit a Wholesale Application to become a LiquorWicks dealer, please fill out the form below.

Please remember to fill out EVERY section with CORRECT information or your application will not be processed!

If you are a human and are seeing this field, please leave it blank.

Fields marked with an * are required

Full Name: *

Company: *

Email *

Address: *

Address (cont):

City *

Zip / Post Code *

Country *

Phone *

Federal Tax ID (EIN) *

Tell us about your Store/Business *

Products Interested In: *

Volume/Quantity Interested In: *

Customization/Private Labeling Needed? *

Timeline? *

Will you need shipping Arranged? *

Any Notes to Add:

What is 6+3 *