Wholesale Registration Form

Not both licenses are required if not available. Please enter a comment at "what products are you interested in" section.
If you prefer to fill out hard copy, scoll down for PDF registration.

Your Full Name*
Company Name*
Type of Business*
Business License
Resale License
Zip Code*
Phone number
Fax number
Attach business license (jpg or PDF)
Attach resale license (jpg or PDF)
What products are you most interested in? (You
can also leave a comment or question here)

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*You can fax the copy of business and/or resale license to 949-582-7204 instead of attaching to this form.
If have any question, please email us at info@alysiaandco.com

*If you rather print out a form to fill out and either fax or email to us, you can print the form (PDF) here. Please remember to fax us a copy of your business and/or resale license.
Note: Bottom half of the PDF form is not required to fill out (noted on instruction on the PDF form).