Dealer Application

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Dealer Application

If you are a retail business and would like to partner with us to become a Lillian Rose Retailer "Dealer", please complete the application below.

You must be authorized as a retail business to receive "Dealer" status. We require a State Resale Tax Certificate. A Customer Service Representative will contact you regarding any additional documentation needed after you submit your application. All information is received in confidence and will not be used for any other purpose. We do not provide this information to any third party. Once your application has been processed and approved, you will receive a username and password to access the wholesale portion of the website to begin ordering.

Please feel free to contact Lillian Rose Customer Service at (800) 521-8760 or email us if you have any questions or need additional information regarding the application process or benefits of teaming up with Lillian Rose and becoming a Retailer.

We look forward to the opportunity of partnering with you to develop a Lillian Rose Program for your retail business!

Fields marked with * are required.

Bill To

* Store Name:

* Address:

* City:

* State:

* ZIP / Postal Code:

* Country:

* Phone:

Fax:

Ship To

Same as Bill To:

* Store Name:

* Address:

* City:

* State:

* ZIP / Postal Code:

* Country:

* Phone:

Fax:

General Information

* Contact Name:

* Email Address:

Website Address:

* Type of Business:

In-Store Only

In-Store and Online

Online Only

* Location of Business:

Commercial Residential

* Years in Business:

* Resale Tax ID Number:

* How did you hear of us:

* Please describe your business:

By submitting this application, I agree to the following Terms and Conditions of this Dealer Application:

I acknowledge that this application is submitted for the purpose of establishing myself as a dealer for products sold by Lillian Rose. I acknowledge that if I am an on-line dealer I must still complete and abide by the Lillian Rose Website Guidelines (separate form). Applicant is a legitimate retail business with a store front and/or retail website and resale tax ID number. All answers are true and complete to the best of my knowledge.

Please enter the following code into the box provided: