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Laguna Wholesale Account Request Form


To receive a Laguna Wholesale account, please complete all information requested below. Your information will be reviewed prior to your account being set up & activated.

All information is kept confidential and will not be shared, or distributed with any other company or individual.

Your Company Name*
Your Full Name*
Type of Business* Retail
If Other
Reseller #(California Only)
Your Title*
Your E-mail*
Your Phone*
Company URL (if any):
Business Address
Zip Code
Brief Description of Store / Business*


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