Services and Supplies not for Resale

Not for Resale Vendor Application

Thanks for joining us at BriarPatch Food Co-op! Please fill out the webform below, including all required fields. Be sure to attach your W9, and insurance certificate (if applicable).

Business Contact Information

Company's Legal Name(Required)

Other Business Name(s)/DBAs

Phone(Required)

Website

Mailing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Mailing Address is Same as Billing Address(Required)

Yes

Billing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Primary Contact Name(Required)

First Last

Primary Contact Email(Required)

Primary Contact Phone

Billing Contact Name

First Last

Billing Contact Email

Billing Contact Phone

Product or Service Information

General Description of Products or Services Offered

(You can also attach a detailed list, including product ingredients.)

Other Information

Your contact or department at BriarPatch with whom you are working, if applicable

0 of 75 max characters

Do you accept ACH payments?(Required)

Yes

What is your invoicing process?(Required)

(Check all that apply.)

Hard copy on delivery

Other

Required Documents

Download a blank W-9 form here.

Completed W-9 form.(Required)

Max. file size: 50 MB.