<p>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!</p><p>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 . </p><p>*please note - only completed applications will be reviewed – all fields are required.</p><p>Company Name Company Website</p><p>Contact Information Primary Contact e-mail Office Phone Mobile Phone Accounting Contact e-mail Office Phone Mobile Phone</p><p>Billing [Street address and zip code must match provided credit card information exactly.]** Telephone</p><p>Street address 1 Street address 2 City State / Province Zip / Postal Code</p><p>Country</p><p>**Fill in all lines. If a field is inapplicable, write N/A.</p><p>Exact Shipping Address [Company Name / ATTN need to be accurate and shippable via UPS] Name/ATTN</p><p>Street address Street address City State / Province Zip / Postal Code</p><p>Country</p><p>Telephone</p><p>General Year Established</p><p>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</p><p>Number of Locations</p><p>Country(s) of Operation</p><p>Sales Outlet/Channel Y/N Brick & Mortar (Physical Location)</p><p>Internet only (E-commerce Business)</p><p>Physical Location + E-tail Business</p><p>Retail Chain/ Franchise</p><p>Do you sell on Amazon/eBay?</p><p>Other (please specify)</p><p>Business Description Top 5 Products/Brands sold / # of years that your Company has sold said products/brands:</p><p>Distributors you buy from [include URLs/specific products]:</p><p>Store description [Include images, press articles, etc as separate attachments]:</p><p>Tradeshows/Expos that you currently attend/purchase from: [name of show / URL]:</p><p>Customer description (demographics/psychographics):</p><p>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</p><p>Online & Social Media URLs (provide full links)** Twitter</p><p>Facebook Pinterest Instagram</p><p>Blog</p><p>Amazon</p><p>Ebay</p><p>Other</p><p>**Fill in all lines. If a field is inapplicable, write N/A.</p><p>Conditional Acknowledgements By my signature below I hereby acknowledge and confirm that:</p><p>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.</p><p>Signature: </p><p>Name: </p><p>Date: </p>