Amazon Intake Form Business InformationName First Last Email Best case scenario would be amazon@yourdomain.com and give us the login details.EIN Number Website Legal Business Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Place of Establishment Address (If different from above) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Office Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business PhoneAmazon DepositsAccount Holder Name First Last *Must match the name on your bank account. DO NOT include the name of the bank itself. Bank Name Bank Account Country Credit Card for Amazon Celler CentralCard Holder Name Credit Card TypeVisaMaster CardAmerican ExpressDate MM slash DD slash YYYY CVV Product InformationProduct Brand Name Name and Cost of Products (including packaging)Product ImageAccepted file types: jpg, jpeg, png, gif.Product Packaging ImageAccepted file types: jpg, jpeg, png, gif.Product ImageAccepted file types: jpg, jpeg, png, gif.Product Packaging ImageAccepted file types: jpg, jpeg, png, gif.Product ImageAccepted file types: jpg, jpeg, png, gif.Product Packaging ImageAccepted file types: jpg, jpeg, png, gif.Product ImageAccepted file types: jpg, jpeg, png, gif.Product Packaging ImageAccepted file types: jpg, jpeg, png, gif.Product ImageAccepted file types: jpg, jpeg, png, gif.Product Packaging ImageAccepted file types: jpg, jpeg, png, gif.Have you purchased UPC, EAN, or JAN for your products? Yes No Link to Product Video Link to Product Video Link to Product Video Link to Product Video Link to Product Video