Dealer Application

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Business Information

Company Name: Date Established:

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Store Information

Street: City: State: Zip:
Phone: Fax: Email:  
Store Hours:

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Shipping Address

Street: City: State: Zip:

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State sales tax number: Website:
Type of business:
-- Select one-- Corporation Partnership Sole proprietorship
Is this a store front business?:
-- Select one-- Yes No Store Size (sq ft): Buyer:

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Bank

Bank Name: Street: City: State: Zip:

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Owner's Information

Name:

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Street: City: State: Zip:
Phone: Fax: Email:

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SUPPLIERS (Hobby Industry preferred)

Name: Account Number:
City: State: Zip: Phone Number:

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Name: Account Number:
City: State: Zip: Phone Number:

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Name: Account Number:
City: State: Zip: Phone Number:

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How did you hear about us?
-- Select one-- Internet Magazine Tradeshow Other
If other, please specify:

Products Stocked:
Categories of Interest

Comments

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