Form

First Name*

Last Name*

What is your primary email address?*

What is your phone number?*

What is your position at the organization?*

What is the full name of your company?*

Which country is your company located in?*

What is the street address of the company?*

Which city is the company located in?*

Which state is the company located in?*

What is your companies online store URL?*

If you don't have an online store enter N/A

Do you have brick and mortar stores?*

If you have brick and mortar stores, please share how many.

Who is your main customer base?*

What are you looking to stock?*

Please name 3-6 major brands that you are currently carrying in your retail location.*

How did you hear about Clove?*

Is there anything else you'd like to tell us about your company?