Trader Vic's

Restaurant Orders Application


Please remember the email address and password you enter, as that information will be required to login as a wholesaler if your application is accepted.

* Indicates a required field.

Prefix: 
 		* First Name: 
 		* Last Name: 
* Company: 
 		* Address: 
* City: 
* State: 
* Postal Code: 
* Email Address: 
*Phone: 
   		* Fax: 
We will be emailing your activation notice to this email address.
Shipping Information
* Shipping Address is: 
 Residential  Commercial 
Check here if Shipping Address is the same as Company Address above.
* Company: 
 		* Address: 
*City: 
* State: 
* Postal Code: 
Business Information
* Class of Business: 
 Proprietorship  Partnership  Corporation 
* Corporation Name: 
 		* State Resale Tax Number: 
New Owner: 
  Check if yes. 		Purchase Date: 
Length of Time in Business:   year(s)
* Business Year: 
 Seasonal  Year Round 
* Type of Business: 
 Gourmet Food Store 
Department Store 
Baskets 
  
 Restaurant/Caterer 
Gift Shop 
Other: 
Comments
Account Information
* Requested Password: