Mimoco, Inc. 119 Braintree St. #106 +1.617.783.1100 tel. Boston, MA 02134 +1.617.783.1122 fax USA www.mimoco.com Thank you for applying for a wholesale account with Mimoco, the MIMOBOT Company!
If you wish to carry MIMOBOT® designer USB flash drives in your store, please provide the following requested information IN FULL* so we can set up your account in our system .
*please note - only completed applications will be reviewed – all fields are required.
Company Name Company Website
Contact Information Primary Contact e-mail Office Phone Mobile Phone Accounting Contact e-mail Office Phone Mobile Phone
Billing [Street address and zip code must match provided credit card information exactly.]** Telephone
Street address 1 Street address 2 City State / Province Zip / Postal Code
Country
**Fill in all lines. If a field is inapplicable, write N/A.
Exact Shipping Address [Company Name / ATTN need to be accurate and shippable via UPS] Name/ATTN
Street address Street address City State / Province Zip / Postal Code
Country
Telephone
General Year Established
Tax ID # Mimoco, Inc. 119 Braintree St. #106 +1.617.783.1100 tel. Boston, MA 02134 +1.617.783.1122 fax USA www.mimoco.com Collect Ship Acct/Carrier*** ***If applicable Number of Employees
Number of Locations
Country(s) of Operation
Sales Outlet/Channel Y/N Brick & Mortar (Physical Location)
Internet only (E-commerce Business)
Physical Location + E-tail Business
Retail Chain/ Franchise
Do you sell on Amazon/eBay?
Other (please specify)
Business Description Top 5 Products/Brands sold / # of years that your Company has sold said products/brands:
Distributors you buy from [include URLs/specific products]:
Store description [Include images, press articles, etc as separate attachments]:
Tradeshows/Expos that you currently attend/purchase from: [name of show / URL]:
Customer description (demographics/psychographics):
Examples of marketing strategy [PR, in-store events, signage POP, etc]: Mimoco, Inc. 119 Braintree St. #106 +1.617.783.1100 tel. Boston, MA 02134 +1.617.783.1122 fax USA www.mimoco.com
Online & Social Media URLs (provide full links)** Twitter
Facebook Pinterest Instagram
Blog
Amazon
Ebay
Other
**Fill in all lines. If a field is inapplicable, write N/A.
Conditional Acknowledgements By my signature below I hereby acknowledge and confirm that:
1. All information provided is accurate. 2. Mimoco has a zero tolerance policy for sales of Mimoco products on Amazon.com. I will not market or sell Mimoco’s products on Amazon.com.
Signature:
Name:
Date: