Wholesale Customer Application

Opening a wholesale account takes a few minutes. Please complete every section and upload your resale certificate at the end. Prefer paper? Download the printable application.

01 · Business identity

Legal business name *

Doing business as (DBA)

Business type *

Retailer / grocery
Restaurant / food service
Reseller / distributor
Other

02 · Contact details

Primary contact name *

Email *

Phone *

Billing street address *

Billing address line 2

Billing city *

Billing state *

Billing ZIP *

Shipping / delivery address

Same as billing address

Delivery street address

Delivery address line 2

Delivery city

Delivery state

Delivery ZIP

03 · Payment & invoicing

Payment terms *

Due on receipt
Net 15
Net 30
Other

Preferred payment method *

ACH / bank transfer
Check
Credit card
Other

Accounts payable contact

Accounts payable email

Send invoices to *

Primary contact
Accounts payable contact

04 · Sales tax & resale certificate

Required for retailers and resellers buying to resell. Restaurants using La Valiente as an ingredient or serving it typically qualify as resale too, so please include yours.

Business located in *

New York
Another state

Sales tax ID number *

Certificate type *

NY Resale Certificate (Form ST-120)
Home-state resale certificate

Upload your resale certificate *

Choose file or drag here

Accepted: PDF, JPG or PNG, up to 20 MB

PDF or a clear photo of the signed certificate

05 · Additional details (optional)

Federal EIN

Referred by

Delivery instructions / receiving hours

Standing order preferences

Notes

I certify the information above is accurate and authorize Mantli LLC (DBA La Valiente) to keep it on file for wholesale invoicing.

Application received

Thank you, your wholesale application is in. We review every application within 2 business days and will email you to set up your account. Questions? hera@lavalientesauces.com · 917.510.3152

Application received

Thank you, your wholesale application is in. We review every application within 2 business days and will email you to set up your account. Questions? hera@lavalientesauces.com · 917.510.3152

Contact information