Bello Lane | Purchasing Partner

COMPANY INFORMATION

Company Name*

Business Type*

Address Line 1*

Address Line 2

City*

State / Province*

ZIP / Postal Code*

PRIMARY PURCHASER

First Name*

Last Name*

Primary Email*

Primary Phone

SECONDARY PURCHASER

Optional

First name

Last name

Contact person email address

Contact person telephone number

SALES TAX EXEMPTION

Do you have a sale tax exemption certificate?*

Please upload the company's sale tax exemption certificate (aka: reseller's certificate)*

I Agree

Signature Block

I agree to abide by the policies set forth by the manufacturers and distributors presented by Bello Lane.