Insert and Forms can be purchased separately at The Florida Pillow Company

Wholesalers Information Submission Form

Please use this form to provide uis with your Business information.

*Bold fields are required

*First Name

*Last Name

Title

Business Name

*Tax Exempt #
(Retail Certificate #)

Street Address

City

State

*Zip Code

*Phone Number

Fax Number

*e-Mail

Contact Method

Products
(Please check all that apply)

What is your budget?

Comments & Ideas

800.560.1631 Toll Free	407.648.9121 Phone Local 407.648.4700 Fax
Note: Orders subject to standard UPS shipping costs.	FREE Delivery! Orders $200+ (Orlando area only)