Xyrena Wholesale Application

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E-Mail for Wholesale Account & Orders(Required)

Enter Email Confirm Email

Must be the e-mail you already used to create a standard Xyrena.com account. If your application is approved then this account will be upgraded to wholesale.

Is your direct e-mail different from the one that will be used to place orders?

Buyer E-Mail(Required)

Enter Email Confirm Email

Name(Required)

Prefix First Last

Legal Business Name(Required)

DBA / Trade Name (if applicable)

Your Role(Required)

i.e. Business owner, buyer, etc.

Phone(Required)

Address(Required)

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

If you have multiple locations please provide your main corporate address here

EIN(Required)

SALES TAX ID(Required)

VAT or GST(Required)

Sales Tax Exemption Certificate(Required)

Drop files here or

Accepted file types: pdf, jpg, Max. file size: 10 MB.

ℹ️ You can find a blank certificate for each state here: https://www.taxjar.com/blog/file/tax-exemption-certificate If you have multiple ship-to locations across different states, please provide one for each. For the seller information, you may use: XYRENA, 9901 Brodie Lane Ste 160-836, Austin, TX 78748

Website

Retailer Type(Required)

Please note, we are not currently seeking online only retailers in the U.S.

Number of Retail Locations(Required)

Which Xyrena products are you interested in carrying?(Required)

Stubz™ Air Freshener Trading Cards

Extrait de Parfum

Pool Boy® Hair Care

Candles

Turnstile