ALIVIO RETAIL PARTNER APPLICATION

888-300-8685

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ALIVIO RETAIL PARTNER APPLICATION

I. PERSONAL IDENTIFICATION

First Name (required)

Middle Name (required)

Last Name (required)

Title (required)

II. RETAIL LOCATION INFORMATION

Name of Business (required)

No. of Employees: (Optional)

No. of Customers: (Optional)

Tex ID: (required)

Type of Bus.Ownership:
S-CorpLLCC-CorpLLPPartnership

Mailing Address (if different): (Optional)

Address, City, State, Zip (required)

III. RETAIL CONTACT INFORMATION

Phone: (required)

Fax: (Optional)

Website: (required)

Purchasing Contact: (required)

Name: (required)

Ext: (required)

Email: (required)

Billing Contact: (required)

Name: (required)

Ext: (required)

Email: (required)

IV. RETAILER OVERVIEW

Type:
ChainIndividualOnline
Store No. (required)

Location:
Main St.Strip MallMall

Retailer Specialty: (required)

No. of Locations: (required)

Additional Services Offered: (required)

Required Documents

- Valid identification issued by federal, state or foreign government agency or entity, provided it contains a photograph, name, date of birth and gender. (Note: If the applicant is not a citizen of the United States, a copy of documentation that permits legal residence must also be provided.)
- Federal Employer Identification Number (EIN) from the IRS (www.irs.gov / 800-829-4933).
- Sales Tax Certificate (front and back) from your state’s Department of Taxation.
- Reseller Certificate (front and back) from your state’s Department of Taxation.
- Franchise/Management Agreement (if applicable)
- Certificate of Incorporation
- Operating Agreement

Privacy Policy

It is the policy of Alivio Products, LLC that personal/tax information about applicants and/or their businesses will be collected only to the extent necessary to evaluate our business relationship; that only appropriate information will be collected; and that the applicant shall understand the reason the information is collected. Social security numbers, dates of birth, and federal and state tax identification numbers are collected for identification purposes. Alivio Products, LLC considers all personal/tax information collected as confidential information and does not provide information to any entity.

Failure to disclose ownership interest in your business or falsification and/or misrepresentation of information may result in refusal of your application

By signing this Application, I certify, agree, understand and acknowledge that this retailer is being considered as an outlet for the distribution of Alivio Products.