Applicant Name and Contact Information:

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* 1. Applicant Name and Contact Information:

Are you are current Gerson Companies customer?

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* 2. Are you are current Gerson Companies customer?

Please provide your E-Commerce sales history (up to 2 years):

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* 5. Please provide your E-Commerce sales history (up to 2 years):

List of websites you are currently using to sell your products (include your business' URL, and insert commas between multiple websites):

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* 6. List of websites you are currently using to sell your products (include your business' URL, and insert commas between multiple websites):

Please provide your business' current Tax ID:

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* 7. Please provide your business' current Tax ID:

E-Commerce Billing/Accounting Information:

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* 8. E-Commerce Billing/Accounting Information:

Please select a Payment Method for your G-Commerce account:

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* 9. Please select a Payment Method for your G-Commerce account:

Please select a Shipment Method for your G-Commerce account:

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* 10. Please select a Shipment Method for your G-Commerce account:

Will you be using FTP for G-Commerce document transmissions?

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* 11. Will you be using FTP for G-Commerce document transmissions?

Please provide your FTP URL and Login Credentials:

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* 12. Please provide your FTP URL and Login Credentials:

Please provide at least one email address as recipient of daily Inventory Feeds (insert semicolons between multiple email addresses):

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* 13. Please provide at least one email address as recipient of daily Inventory Feeds (insert semicolons between multiple email addresses):

Please provide at least one email address as recipient of Order Confirmations (FTP users only):

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* 14. Please provide at least one email address as recipient of Order Confirmations (FTP users only):

Please provide at least one email address as recipient of Shipment Tracking notifications (insert semicolons between multiple email addresses):

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* 15. Please provide at least one email address as recipient of Shipment Tracking notifications (insert semicolons between multiple email addresses):

Select the product lines from the Gerson Family of Brands that you are interested in selling on your E-Commerce website:

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* 16. Select the product lines from the Gerson Family of Brands that you are interested in selling on your E-Commerce website:

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