LIALOHA — Wholesale Account Application

🏪

Business Information

Your store or company details

Business Name *

Please enter your business name.

Business Type *

Please select a business type.

Years in Business

Tax ID / EIN *

Please enter your Tax ID or EIN.

Resale License Number

Website / Social Media

Business Address *

Please enter your full address.

👤

Contact Information

Primary contact person

First Name *

Required.

Last Name *

Required.

Title / Role

Email Address *

Please enter a valid email address.

Phone Number *

Please enter a phone number.

Preferred Contact Method

Additional Notes

💳

Payment Method

Select your preferred payment option

💳

Credit Card

📝

Check

💵

Cash on Delivery

🏦

ACH / Wire

Please select a payment method.

💳 Credit Card Details

▣

•••• •••• •••• ••••

Card Holder

—

Expires

—

Card Number *

Please enter a valid card number.

Expiry *

Required.

CVV *

Required.

Name on Card *

Required.

Billing Zip Code

🔒 Your card information is transmitted securely. We do not store full card details on our servers.

🏦 ACH / Wire Transfer Details

Bank Name *

Required.

Routing Number *

Required.

Account Number *

Required.

Account Type

🔒 Banking information is encrypted and used only for payment processing.

✅

Review & Submit

Please verify your information

I certify that all information provided is accurate. I agree to LIALOHA's Wholesale Terms & Conditions and Privacy Policy.

You must agree to the terms to proceed.

🌺

Application Submitted!

Thank you for applying to become a LIALOHA wholesale partner.
We'll review your application and reach out within 1–2 business days.

Confirmation sent to your email