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Colorado Bicycle Helmet Visors:  Wholesale Login

To become a wholesaler for Wide-Eyez, please complete the form below:


New Customer *
Buisness Name *
Shipping Address *
Principal Owner 2 - Full Name/Title
Legal Corporate Name
City/State/Zip *
Home Address
Legal Owner *
Principal Owner - Full Name/Title
City/State/Zip
Billing Address *
Home Address
SS#
City/State/Zip *
City/State/Zip
DOB
Website *
SS#
Home Phone
Phone Number *
DOB
Email Address *
Email Address
Email Address
Type of Ownership *
 Sole Proprietorship
 Partnership
 Corporation
 LLC
Terms Requested *
 COD
 Credit Card
 Net 30
Please provide 3 vendor references: Name of Company, Address, Contact, Phone and Email *