Wholesale Application Form

To order wholesale from Long Creek Herbs please fill out the information below and email us for processing and approval within one or two business days. (If you prefer, you can call us with this information Monday thru Friday, 8am-5pm Central time, and receive immediate processing.)

Call us at 417-779-5450

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1 Step 1

Become a Retailer Today!

Billing Information

First Name(Required)

Last Name(Required)

Company Name/d.b.a.(Required)

Tax Resale Number or Equivalent(Required)

Type of Business(Required)

Email(Required)

Daytime Phone(Required)

Web Address(Optional)

Address(Required)

City(Required)

Zip(Required)

Shipping Information

Check if same as Billing Address

First Name(Required)

Last Name(Rquired)

Address(Required)

City(Required)

Zip(Required)

Shipper Account Number

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