New Wholesale Customer Sign Up - El Roi Mexican Imports

Personal Information

First Name

Last Name

Sign-in Information

Username or E-mail*

Password*

Confirm Password*

Company Legal Name

Doing Business As (Store Name)

Shipping Address - We do not approve Residential Address and P.O Box as a Shipping Address

Address Line 1

Address Line 2

City

Zipcode

Country

Province / State

Website

Phone Number

Type of Business

Business Number

No. of Store

How did you learn about our company?

What is the amount of your expected monthly purchase?

Business Owner Signature

Owner First Name

Owner Last Name

Date / Time

Only fill in if you are not human