Download PDF application form here

TO BE COMPLETED BY APPLICANT:

Today's Date:

INSTRUCTIONS:

PLEASE TYPE OR PRINT CLEARLY

  1. Please complete all information requested. Failure to do so may cause a significant delay in the processing of your application, and possibly order delivery.
  2. For domestic US, attach a copy of your business license & resale certificate. For international, attach a copy of your business license or business documents.
  3. All new applicants who have a brick & mortar store will be required to submit a photo of the store front. Online retailers will need to submit the website address.

THE ABOVE BUSINESS DOCUMENTS ARE REQUIRED TO BE APPROVED

NOTE: ALLOW 7-14 DAYS TO PROCESS AND TO RECEIVE NOTIFICATION ON YOUR APPLICATION CORPORATE INFORMATION

Corporate Name: d / b/ a :

Address:

City:

Country State/Province:

Zip:

Telephone Number:

Type of Business:

Federal Tax ID#:

Owner/Officer Names:

Buyers Name:

A/P Contact:

Nature of Business:

Number of Stores:

Fax:

Brick & Mortar & Online Email:

Other (Please indicate)

Telephone #:

Telephone #:

Brick & Mortar (  ) Online (  ) ( Resale ID#: ) (  ) :

If you have multiple stores, please fill out section "Store Information" and "Store Information - Additional" for each store.

STORE INFORMATION (Info below will be added to ModestLily's Store Locator once first order has been placed.)

Type of Business:

Brick & Mortar (  ) Online (  ) Brick & Mortar & Online (  ) Other (Please indicate) (  ) :

Store Name:

Address:

City:

State/Province:

Zip:

Country  Telephone Number:

Store Hours:

Website Address:

Type of Styles Sold in Store:

Casual (  ) Work Wear (  ) Maxis (  ) Cocktail (  ) Evening (  ) Wedding (  ) Accessories (  )

Sizes Sold in Store:

0-10 (  ) 12(  ) 14/16 (  ) 18/20 (  ) 22/24 (  ) 26/28 (  ) 30/32 (  ) 30/32+ (  ) Other(Please indicate) (  )

Average Store Price Point:

$1-$75 (  ) $75-$150 (  ) $150-$225 (  ) $225-$300 (  ) $300-$375 (  ) $375-$450 (  ) $450+ (  )

Target Age Audience (Select all that apply):

Under 18 ( ) 18-25 ( ) 25-35 ( ) 35-45 (  ) 45-55 (  ) 55+ (  )

Number of Years in Business:

1 (  ) 2-4 (  ) 5-7 (  ) 8-10 (  ) 11-13 (  ) 14-16 (  ) 17-19 (  ) 20+ (  )

If store is new, date of store opening (  /  /    ):

Plus size brands carried in store:

Fax:

Email:

STORE INFORMATION - ADDITIONAL (For ModestLily only. Will not be added to store locator.)

Other brands carried in store:

Referral Source:

Word of Mouth (Indicate Name) (  ):

Wholesale Directory (Indicate Directory)

Tradeshow (Indicate Tradeshow) (  ):

Internet Search (Indicate Search Term Keywords Used)

Blogger (Indicate Name) (  ):

Other (Please specify) (  ):

Brief Company/Store Description: (  ): (  ):

Additional Comments:

DESIRED WHOLESALE LOGIN CREDENTIALS

Email Address:

Password:

BILLING INFORMATION

First & Last Name:

Company Name:

Address:

City:

State/Province:

Country Telephone Number:

Zip:

Email:

SHIPPING INFORMATION

First & Last Name:

Company Name:

Address:

City:

State/Province:

Country Telephone Number:

Do you have a FEDEX account # you would like to use for your ModestLily shipments?

*NOTE: If you prefer to use your FEDEX account for shipments, all orders must be submitted to wholesale@modestlily.com. All orders submitted on the wholesale site will automatically be shipped using ModestLily's shipping provider.

Zip:

Yes Email:

No FEDEX ACCT #:

PREFERRED PAYMENT METHOD

Credit Card: (  )

PayPal (Indicate PayPal email address): (  )

Bank Wire (Requires an additional $40 fee): (  )

AUTHORIZATION - REQUIRED

Print Name:

ModestLily's Reseller Terms & Conditions:

(  ) Read & Acknowledge Authorization

By printing your name below & clicking "Submit", you indicate your authorization for all the above information:

X

release of information to ModestLily: (  )