
Customer Service: 1-800-9-COPAG-1 Wholesale Inquiries: 1-866-9-COPAG-1

Reseller Application

Please fill out the following application. You will be contacted via email with the status of your application.

* indicates that the field is required.

Username:	*
Password:	* (6-12 chars)
Retype:	*

Email:	* (eg. info@copagcards.com)
Phone:	(eg. 317-555-1212)
Website (if any):	(eg. www.mysite.com)
Mailing Address:

Contact Name:	*
Business Name:	*
State Tax Id or SSN:
Current Copag Distributor (if any):
How long have you been in business?
	Under 1 year 1-2 Years 3-5 Years 5+ Years
What type of business do you have?
	Retail Storefront Online Store Gaming Club Other
How do you intend on selling the cards?
Do you already have an existing account with Copagcards? (now applying for online account)
	No Yes
Additional Comments: