Rishi Tea Wholesale Registration

Please complete the following form to request wholesale information. A Rishi representative
will contact you shortly. Required fields are yellow. 

Your Company Information:

Are you an existing Rishi Tea Reseller?: 

No Yes

Your Company Name: 

Type of Business 

Reseller Permit Number: 

A resellers permit number will be required to set up a wholesale
account. If you do not know your number or if you have applied but
not yet received it, please enter TBD.

Your Primary Contact & Billing Information:

First Name: 

Middle Initial: 

Last Name: 

E-Mail: 

Confirm E-mail: 

Address: 

City: 

State: 

Select One: ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE >NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING

Zip: 

Phone: 

Fax: 

Your  Website: 

http://

Your Primary Ship To Information:

Check if Ship To is Same as Bill To:

Ship To Company Name: 

Ship To Address: 

Ship To City: 

Ship To State: 

Select One: ALABAMA ALASKA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FLORIDA GEORGIA HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE >NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA OHIO OKLAHOMA OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING

 Ship To Zip: 

Ship To Phone: 

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