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Merchant Account Application
Please complete all relevant information
Application Type Products Services
Company Information
Company Name
Headquarters Address
Product/Services you intend to sell
Website Address
Primary Contact Information
Your Name
Title
Email:
Address
City
State/Province Other
Postal/Zip Code
Country
Phone Fax
Accounting Contact Information
Name:
Title
Email
Phone Fax
Product Support Contact Information
Name
Title
Email
Phone Fax
Shipping Contact Information
Name
Title
Email
Phone Fax
Drop Ship Fee (if applicable)
Will you be charging sales Tax? No Yes

By submitting this application I hereby acknowledge that I have read and accept all the terms and conditions of my agreement with Housewares Depot. I also certify that I am authorized to represent my company.
Confirmation Code
Enter the code

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