Adaptiv Retailer Portal

Fields marked * are required. All other fields are optional. Your application will be saved when you continue.

Business information

Legal business name *DBA (if applicable)Business type *Years at this addressStreet address *City *State *ZIP code *Federal Tax ID (EIN)D&B numberResale certificate numberBusiness phone *Email *Website

We’ll reuse this email in the remaining contact fields. You can change any prefilled address.

A valid, approved resale certificate is required before the account can be approved or place wholesale orders.

Primary delivery address

Leave the address blank to use your business address. Add delivery contacts and instructions for either address.

Delivery contactPhoneDelivery days and hoursSpecial delivery instructionsStreet addressCityStateZIP code

Do you have additional ship-to locations? No Yes

If yes, we’ll collect the additional delivery locations during review.

Primary contact

Name *Title *Email *

Accounts payable

NameEmail

Store locator contact