retailers Authorized Retailer Request Form Contact Us Company name * Contact Name * First Name * Last Name Contact Phone * Contact Email * Location of Facility (City, State, ZIP) * Company EIN Federal Tax ID (If you don't have this on hand immediately, you may still submit form. Please note it will be required to process first order). Where would you like to sell Detroit Dough (check all that apply to your operation) * Supermarket chain (5+ locations) Independent market (1-4 locations) Single location market Restaurant (5+ locations) Restaurant (1-4 locations) Boutique Hotel Other Please list additonal location(s) of proposed retail outlet(s) and any additional information you would like us to consider. If you are human, leave this field blank. Submit
