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WHOLESALE BUYER APPLICATION
If you would like to access our designer pages and store catalog, please fill out the required information below. We will process your wholesale buyer information and reply with your buyer's code and instructions on how to use it. Please note this website is not for the retail consumer. It is for wholesale buyers only. Thank you for your interest in the designers of Tim Philbin Accessories.

Personal Info
* First Name: * Last Name:
* Store Name: * Buyers Name:
* Phone: Fax:
* Customer Type:
(In order to select multiple selections hold the ctrl key) 		* Interest:
(In order to select multiple selections hold the ctrl key)
* Email: * How did you here about Tim Philbin:
* Tax ID/Business License:    

Billing Info
* Address1: Address2:
* City: * State:
* Country: * Zip Code :

Shipping Info
Check if shipping address is same as billing address
* Address1: Address2:
* City: * State:
* Country: * Zip Code :

By submitting this form I am indicating that, to the best of my knowledge, all the above information is correct.
 

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