Retailer Application
Must Have Brick-and-Mortar Store Front

Please review your information before submitting. 

This Form cannot be submitted until the missing fields (labelled below in red) have been filled in
Please note that all fields followed by an asterisk must be filled in.
Business Name*
Contact Name*
E-Mail Address*
Business Phone*
Fax
Street Address*
City*
State/Prov*
Zip/Postal Code*
Resale ID Number*
Number Of Stores You Currently Operate*
Type of Retail Operation*	Book Store Children's Clothing Country Club/Pro Shop Furniture Gift Shop Home & Garden Hospital Gift Shop Hair Salon/Spa Shoe Store Other
If Other (please state)
Type of Merchandise Currently Carried in Store(s)*	Accessories Beauty Children/Infants Footwear Handbags Home Housewares Gifts Men's Women's
List Key Brands in Store(s)*
How did you hear about us?*

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