Welcome to the Wholesale Inquiry Form

Once your form is submitted, someone from our Wholesale Team will be in touch within 2 business days. We appreciate you checking us out!

Wholesale Application Form

First Name*

Last Name*

Email Address*

Cell Phone Number*

Company Name*

Your Website

Address Information

Street Address*

Street Address Line 2

City*

State*

Zip/Postal Code*

Country*

Business Information

Tell Us About Your Business.*

How would you describe your business structure?*

How many locations does your business have?

What Market Segment best describes your business or audience?*

To become a Wholesale Partner, submit your Company Tax ID*

How did you hear about us? *

Referred by someone? Details*

Create your ENERGYbits Coupon code (4-10 characters, do not use any numbers or the words "ENERGY" or "BITS")

Upload completed W-9 to qualify for Wholesale Partner program

Other Information

Facebook Username

Instagram URL

Please checkbox to Agree To our Terms and Conditions* Click to view our terms and conditions

LinkedIn Profile