Wholesale Account Registration

Thank you for your interest in Mocha Tree Organics! If you would like to carry our plant-based apothecary collection, please complete the buyer profile below. This enables our team to establish your ordering and billing account. After setup, you can conveniently place orders through our website using the provided account credentials, sent to the billing contact's email unless specified otherwise.

Please note that required fields are marked with an asterisk (*).

Account & Billing Information

First Name

Last Name

Business Name

Email Address

Phone Number

Website

Billing Address

City

State

ZIP Code

Special Instructions

Ship To (if different from billing address)

Shipping Address

City

State

ZIP Code

Special Instructions

About Your Business

What is your business model? (Please check all that apply)

Online

Brick and Mortar

Subscription Box

Mobile Boutique

Other

Tell us about your business

Please share your social media handles

How did you hear about Mocha Tree Organics?

Sales Tax Exemption

In order to claim tax-exempt status for your purchases, please complete, save, and upload the General Sales Tax Exemption Certificate (ST-105). Please note that your business must be registered with the Department of Revenue or the appropriate taxing authority for the state where your business resides.

Required

Upload .pdf

Confirmation

I hereby certify and confirm that all of the information on this form is correct and accurate. Additionally, I consent to doing business and conducting transactions electronically.

By signing my name electronically, I am agreeing that my electronic signature is the legal equivalent of my manual signature.

Typed Name

Role or Title

Submit Registration