Wholesale Customer Application Page

Coming soon

Welcome to Chickadee Farm Herbs.

If you would like to become a wholesale customer, you are a business, please fill out the following form. We will review the form and get back to you with a password for the wholesale portion of our website. 

Wholesale Application Form

Please enable JavaScript in your browser to complete this form.

Name *

First

Last

Business Name

Phone number *

Email *

Website

Business Address *

Address line 2

Town/City *

Postal Code *

Shipping Address (if different from business address)

Shipping Address line 2

Shipping Town/City

Shipping Postal Code

Reference 1: Bank Name and contact information

Fill out this part if you would like terms (30 days) with Chickadee Farm Herbs. References Chickadee Farm Herbs Ltd. has permission to contact.

contact from

Reference 2: Supplier Name and contact information

Fill out this part if you would like terms (30 days) with Chickadee Farm Herbs. References Chickadee Farm Herbs Ltd. has permission to contact.

Reference 3: Supplier Name and contact information

Fill out this part if you would like terms (30 days) with Chickadee Farm Herbs. References Chickadee Farm Herbs Ltd. has permission to contact.

Signature: *

I/We agree to the terms and conditions set out in the Chickadee Farm Herbs Ltd. Wholesale Price List.

Submit