Distributor Register – Aspen Tree Performance Mushrooms

Primary Contact

Main contact responsible for distributor communication, approvals, and account access.

First Name*

Last Name*

Title / Role*

Email Address*

Mobile Phone*

Office Phone

Create Username*

Letters, numbers, underscores, hyphens, or periods.

Create Password*

Use at least 8 characters.

Distributor Business & Tax Information

Business verification, tax details, territory coverage, and documents required for distributor review.

Legal Business Name*

DBA / Trade Name

Distributor Type*

EIN / Federal Tax ID*

9 digit federal tax ID.

Business License Number

State of Incorporation*

Years in Business*

Company Website(s)*

Enter one or more websites. Use one URL per line. Examples: test.com, test.co.uk, https://test.com.

Warehouse / Branch Locations*

States / Regions Served*

Distributor Territory Covered*

Distribution Channels*

Sales Rep

Upload W-9*

PDF, JPG, PNG, WEBP, DOC, or DOCX. Max 10MB.

Upload Resale Certificate*

PDF, JPG, PNG, WEBP, DOC, or DOCX. Max 10MB.

Sales Tax Exemption Certificate

PDF, JPG, PNG, WEBP, DOC, or DOCX. Max 10MB.

Business License Document

PDF, JPG, PNG, WEBP, DOC, or DOCX. Max 10MB.

Distributor / Vendor License Document

Optional. Upload any distributor, vendor, warehouse, or compliance document. Max 10MB.

Billing, Warehouse & Logistics

Accounts payable, billing address, warehouse receiving, and logistics capability details.

Accounts Payable Email*

Purchase Orders Required?*

Billing Street Address*

Billing City*

Billing State*

Billing ZIP*

Primary warehouse / receiving address is the same as billing address

Warehouse / Receiving Company Name

Warehouse Street Address*

Warehouse City*

Warehouse State*

Warehouse ZIP*

Warehouse / Logistics Contact*

Receiving Phone*

Logistics Email

Receiving Hours

Delivery Appointment Required?

Loading Dock Available?

Pallet Receiving Capable?

LTL / Freight Capable?

Delivery Coverage Type

Warehouse Square Footage

Warehouse / Order System

Warehouse / Freight Instructions

Distributor Snapshot & Agreement

Sales network, purchase capacity, distributor operations, and final agreement details.

Annual Revenue Range

Estimated First Order

Expected Annual Purchases

Primary Distribution Focus

Monthly Purchase Capacity

Active Retail / Reseller Accounts

Number of Sales Representatives

Number of Delivery Routes

Existing Brands Carried

Territory Growth Plan

EDI Capable?

Dropship Capable?

Additional Notes

Electronic Signature Name*

Signature Title*

Signature Date*

I certify that all information provided is accurate. *

I understand submission of this application does not constitute approval for purchasing. *

I agree to Aspen Tree's Terms & Conditions. *

Account & Order History

Apply for Distributor Access

Thank you. Your application was submitted successfully.

Primary Contact

Distributor Business & Tax Information

Billing, Warehouse & Logistics

Distributor Snapshot & Agreement

10-DAY GUARANTEE

STAY LOCKED IN

THIRD PARTY LAB TESTED