Please Complete the Following Information to Receive Access to Wholesale Pricing Business Name Bill To Address Ship To Address Phone Number Fax Number Email Address Contact Name Federal Tax ID #Additional Comments: * Additionally, we require a valid copy of your Reseller Certificate be either Faxed to 407-855-5941, or Emailed to customercare@jerryleigh.com Upon application approval, notification will be sent confirming your access to our wholesale selections Please enter the following code into the box provided: