Retail Store & Boutique Application Want to carry Cup of Coa products in your store, gift shop, boutique, etc? Please submit our Wholesale Vendor Application Agreement! Company Name(Required) Phone Number(Required)Fax NumberBilling Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Is shipping address same as billing address?(Required) Yes, my shipping address is the same as my billing address. No, my shipping address is not the same as my billing address. Shipping Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Company Website(Required) Email (to contact & send invoices/tracking info)(Required) Owner/President First Last Number of Years in Business Other Store Locations How did you hear about Cup of Coa?(Required) Buyer InformationName of Authorized Buyer(Required) First Last Email(Required) Phone NumberAccounts Payable InformationName of Authorized Buyer(Required) First Last Email(Required) Phone NumberTerms and ConditionsAgent’s Authority to Act: By submitting this form, you verify that you have authority to act on behalf of your Company and bind it to the terms and conditions herein. Shipping: All prices are F.O.B. Cup of Coa, LLC, Kearney, NE, USA and the method and route of shipment are at Cup of Coa, LLC’s discretion. Cup of Coa, LLC, does not offer cost-delivered pricing and does not provide shipping estimates. Taxes: You are responsible for the payment of applicable federal, state, and local taxes unless an appropriate government tax exemption form is provided to Cup of Coa, LLC, in advance. Payment: Payment is due in full at the time of the sale, including shipping and handling and applicable taxes. If Cup of Coa, LLC, in its sole discretion, extends credit, all invoices are due within thirty (30) days of the invoice date unless otherwise agreed in writing. A service charge of one and one half present (1.5%) per month shall be assessed on delinquent invoices. Price Changes: Cup of Coa, LLC, reserves the right to change its pricing and fees for its products and services at its discretion. Cancellation and Return of Product: Once an order has been placed and processed by Cup of Coa, LLC, it may only be cancelled with the consent of Cup of Coa, LLC. Items may be added to processed orders, but additional product and shipping charges will apply. If, with the consent of Cup of Coa, LLC, a processed order is cancelled, a 20% restocking fee shall apply. Any product returns shall occur within thirty (30) days of delivery of the product and will be solely at buyers expense. Any refund for returned product will be determined in the sole discretion of Cup of Coa, LLC, and may incur a 20% restocking fee. If Cup of Coa, LLC, determines that a refund is warranted, Cup of Coa, LLC will refund said funds within forty-five (45) days of Cup of Coa’s receipt of the returned product. Controversies: All controversies or disputes arising out of, or in any way related to, your solicitation for, or ultimate purchase of, product from Cup of Coa, LLC, shall be subject to the laws of the State of Nebraska and shall be brought in the appropriate state or county court located in Buffalo County, Nebraska, or in the United States District Court, District of Nebraska. Retail Only: By signing this document, you agree as an authorized representative of your company, to act and sell Cup of Coa, LLC’s product as a retail store only and not as a wholesale distributor. Further, you agree to sell Cup of Coa, LLC’s product at or above the Minimum Resale Price as outlined in the Cup of Coa, LLC’s price sheet at the time of sale. Cup of Coa, LLC, strives to provide a quality product with outstanding customer service, however, we recognize that our product has the potential to become damaged during shipping. It is your obligation to contact us immediately, and within 30 days of the product’s delivery, if your order arrives with any damage to the packaging affecting the product so that we may file a claim with the shipping company. By submitting this application, I agree on behalf of the above company to the terms of this document.Name of individual submitting this form(Required) First Last Email we can use to contact you with questions about your application(Required) Δ