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Retailer Application

children wearing pediped footwear

Thank you for your interest in pediped® footwear. pediped® does not currently accept applications from consignment stores or stores that sell used goods.

Retailers outside of the US please click here to fill out our international application.

Copies of your federal tax ID and resale tax ID must be faxed with your first order. Please take a few minutes and fill out this online application.  You will be notified once you are approved. 

If you have any questions regarding the status of your application, please contact customerservice@pediped.com.


* First Name:   * Last Name:  
Title:
* Store Name:  
* Federal Tax ID#:   * Resale Tax ID#:  
All new U.S. accounts must have a federal tax ID and Resale tax ID to open a new account.
If you do not have one of the above, type N/A and explain why in the section below:
VAT#:  (if applicable)
* Email:     * Confirm Email:    
Website URL:
* Phone #:     Fax #:  
Mailing Address
* Street Address:  
* City:   * State/Province:  
* Zip/Postal Code:   * Country:  
Store Address
* Street Address:  
* City:   * State/Province:  
* Zip/Postal Code:   * Country:  
* Type of Retailer:  
* Specialty:       
* Merchandise:
    
* Price Range of Merchandise:  
Describe your store
* Location:  
* Clientele:  
* Décor:  
* Size (sqft or sqm):  
Other Details:  
The more you can describe your store in detail, the better it will assist us in approving your wholesale status.
* Is your store currently open?   * If yes, how many years has it been established?  

* How many (brick & mortar) store locations do you have?
Name 3 brands that you carry or plan to carry.
* Brand 1:  
* Brand 2:  
* Brand 3:  
* Other Brands:
How did you hear about us?
Trade Magazine:




 		Consumer Magazine:
Trade Show:








 		Misc:
Comments or Questions:
 

By submitting this application, you agree that you have read our wholesale policy and agree to the terms outlined. Customers who sell below MSRP or auction sites, such as ebay will not be shipped again. Click here to read our wholesale policy.