Business Application Form
Business Name (DBA):
Tax ID / Resale #:
Business Type:
Wholesaler
Importer
Retail
Boutique
Specialty chain store
Department store
Buying office
Internet biz
Other
Your Product Line:
Art Glass
Interior Design
Furniture
Jewelry
Specialty Gift
Other
if other, indicate
Number of Years in Business:
Annual Sales:
Number of Employees
Contact Name:
Position:
Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
Email Address:
How did you hear about us?
Comments: