REQUEST TO SELL ON WALMART MARKETPLACE

First Name:

Last Name:

Email Address:

Company Name:

Address:

City:

State:

Zip Code:

Country:

Phone Number:

Mobile Phone Number:

Industry Category:

Website:
(ie: Must include http:// or https://)

Annual Online-Only Revenue Range:

Marketplace URL:
(example: URL to Amazon Marketplace)

Estimated # SKUs:

Average Selling Price:

Amazon Customer Rating Count:

Are you a ChannelAdvisor Customer?

Have you already been approved to sell on Walmart.com?

Campaign ID:

Channel:

Sync to Marketo (C):

Sync to Marketo: