Become a WIN Retailer - WIN Detergent

To complete this form, you will need:

Your Legal Company name and mailing address
Your store brand name, if different from your legal name
Your Federal Tax ID, and your state Sales Tax ID (they're the same in many states)
Your store's Facebook, Twitter, and Instagram links, so we can easily direct WIN fans to you
The name and contact info for our primary contact at your store

Once you have that information available, the application should take no more than 5 minutes to complete.

We're excited to have you aboard!

Company Information
Primary Contact Information
Online / E-Commerce Info
Additional Information

Company Information

Public Name / Brand of Store *

Company Legal Name *

Company Mailing Address *
Address 2

City *

State/Province *

Zip/Postal Code *

Country *

How many physical locations do you have? *

Are all of your locations in the same state as your mailing address? *

Yes No

State Sales Tax ID *

Federal Tax ID *

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Primary Contact Information

Primary Contact Name *

Primary Contact Title *

Primary Contact Email *

Primary Contact Phone *

Alt Phone

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Online / E-Commerce Info

Company Website *

Facebook Page URL

Twitter Feed (Include @)

Instagram Account (include @)

Pintrest Account (include @)

Do you plan to sell WIN on your web site? *

Yes No

If so, please provide the URL(s) for your E-Commerce site(s)

Amazon, Ebay, and Other marketplaces *

We understand and agree that WIN's terms and conditions DO NOT allow us to sell on Amazon, Ebay, or any other online marketplace. We agree to sell WIN only on URLs that represent public store brand(s) owned by us.

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Additional Information

Have you been a WIN Dealer Before? *

How did you hear about WIN? *

Anything else you wish to tell us?

Should be Empty: