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Wholesale Dealer Application
Wholesale Dealer Application
Thank you for your interest in the Patagonia Dealer program.
Please complete the form as accurately as possible.
Applicant
First Name
*
*
Last Name
*
*
Email
*
*
*
Job Title
*
*
Business Phone
*
*
Mobile Phone
*
Company / HQ
Company Name
*
*
Trade Names
*
Website URL
*
*
Additional URLs
*
Address
Is Delivery Address same as Invoice Address?
Is Delivery Address same as Invoice Address?
No
Is Delivery Address same as Invoice Address?
Yes
Invoice Address
*
*
Maximum 3 address lines, 35 characters each
Delivery Address
*
Maximum 3 address lines, 35 characters each
City
*
*
Delivery City
*
State / Prov.
*
*
Postal Code
*
*
Delivery State / Prov.
*
Delivery Postal Code
*
Business Contacts
Manager
Is Applicant
Is Applicant
No
Is Applicant
Yes
First Name
*
Last Name
*
Email
*
*
Mobile Phone
*
Business Phone
*
Owner
Is Applicant
Is Applicant
No
Is Applicant
Yes
First Name
*
Last Name
*
Email
*
*
Mobile Phone
*
Business Phone
*
Accounts Payable
Is Applicant
Is Applicant
No
Is Applicant
Yes
First Name
*
Last Name
*
Email
*
*
Mobile Phone
*
Business Phone
*
Please provide the first name, last name, and email address for each buyer that will need access to our ordering website.
*
*
Details
Are you applying because you're the new owner of an existing authorized Patagonia dealer?
*
Are you applying because you're the new owner of an existing authorized Patagonia dealer?
No
Are you applying because you're the new owner of an existing authorized Patagonia dealer?
Yes
Seller's Permit (Resale or sales/use tax #)
*
*
Requested Credit Limit (numbers only, no special characters)
*
*
*
Projected Open Buy (numbers only, no special characters. Patagonia has an annual $10k minimum)
*
*
*
Shop Type
*
Outdoor Specialty
Sporting Goods
Lifestyle / Dept Store
Snow Specialty
Fishing Specialty
Surf Specialty
Other
Ownership Type
*
Corporation
Proprietorship
Partnership
Business Model
*
Brick and Mortar
Brick and Mortar with Website
Drop Ship
Website
Years in Operation
*
0 to 2
3 to 5
6 to 10
10+
Number Of Locations
*
*
*
Total Floor Space
*
*
*
Other Relevant Experience
*
Please list all additional storefronts (store name and address) where Patagonia would be sold.
*
*
Do you share your on-hand inventory with Locally.com?
*
Do you share your on-hand inventory with Locally.com?
No
Do you share your on-hand inventory with Locally.com?
Yes
What are your top performing vendors?
*
*
How do you envision Patagonia complementing your existing best in class products?
*
*
Purpose
What is your company's mission statement (ie your reason for being in business)?
*
*
How do you give back to your community?
*
*
Are you willing to utilize our Mission Statement ("We are in business to save our home planet") in-store and/or online?
*
*
Do you utilize renewable energy? This includes carbon offsets and/or buying renewable energy.
*
*
Do you buy or sell used apparel? Do you offer apparel repairs or gear rentals? If yes, please describe.
*
*
Why do you want to carry Patagonia?
*
*
Memberships / Attachments
1% for the Planet
1% for the Planet
No
1% for the Planet
Yes
Certified B Corporation
Certified B Corporation
No
Certified B Corporation
Yes
Grassroots Outdoor Association
Grassroots Outdoor Association
No
Grassroots Outdoor Association
Yes
Additional Information or Notes
*
*
Upload photos of your store. Press [Ctrl] or [CMD] and select up to 5 files. Total of all photos is limited to 100 MB. Exterior and interior photos are required.
