Wholesale Account Application

Thank you for visiting Cobalt Aquatics!

Wholesale Application

Company Name *

Full Name *

Email *

Store Phone Number (optional)

Cell Phone Number *

Website

Password *

Password Confirmation *

To help us identify your business please include your social media link

Address1 *

Shipping Address (If Different)

City *

Country *

State/Province *

Zip/Postal Code *

Note: Receiving Days/Hrs *

Upload Document

Tax Exempt # (Resell Certificate)

Upload Certificate of Exemption

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I accept the Terms and Conditions

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