Apply to Join — Club12

Business Information

Tell us who you are and where you're located.

Business Name *

Please enter your legal business name.

EIN (Employer Identification Number) *

Please enter a valid 9-digit EIN (XX-XXXXXXX).

DUNS Number (optional)

Please enter a valid 9-digit DUNS Number.

Store Name *

Please enter the store name.

Website (optional)

Please enter a valid website address.

Number of Locations *

Please enter a valid number of store locations.

Business Address *

ZIP Code *

Please enter a valid 5-digit ZIP Code.

Street Address *

Please enter the street address.

City *

Please enter the city.

State *

Please select the state.

Delivery Address (if different from address above)

ZIP Code

Please complete the full delivery address.

Street Address

Please complete the full delivery address.

City

Please complete the full delivery address.

State

Please complete the full delivery address.

Contact Information

Who should we reach out to?

Full Name *

Please enter the full name of the primary contact.

Position *

Please enter the contact person's position.

Email *

Please enter a valid email address.

*** Use an email address that you check regularly. This is where we'll send launch opportunities and important Club12 updates.

Phone *

Please enter a valid U.S. phone number.

Tell Us About Your Store

What do you sell, and how?

Review & Submit

Double-check the details below, then send it off.

At the time of product selection for your Club12 launch, you will be asked to provide basic, non-confidential information about comparable products in your store, including their current weekly sales velocity.

Please confirm your agreement before submitting the application.

Club12 Member Application

Business Information

Contact Information

Tell Us About Your Store

Review & Submit

You're in!