Adaptiv Retailer Portal

Retail Partner Information

Legal Business Name *DBA (if applicable)Business Entity *Years at this addressStreet Address *City *State *ZIP *Federal Tax ID (EIN)D&B #Sales Tax Resale #Telephone *Email *Website

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

Shipping Address

If different from billing address

Delivery Contact NamePhoneDelivery Days & HoursSpecial Delivery InstructionsAddressCityStateZIP

Do you have additional ship-to locations? No Yes

If yes, the ADAPTIV SLEEP team will request the additional location details during review.

General Contact Information

Name *Email *

Accounts Payable Contact Information

NameEmail

Dealer Locator Contact Information