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Electric City Roasting B2B Customer Form
Please fill out the form below and a representative will reach out to you ASAP and help you set up a wholesale account.
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Email
*
Your email
Name
*
Your answer
Business Name
*
Your answer
Phone Number
*
Your answer
Shipping Address
Street:
City:
State:
Zipcode:
*
Your answer
Billing Address, If it is the same as your shipping address, please denote this.
Street:
City:
State:
Zipcode:
*
Your answer
What type of business are you? (ex. Cafe, Restaurant, Retail)
Your answer
What sort of products' are you looking for? If you are unsure, leave blank.
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