| Company
Name: |
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| Address
1: |
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| Address
2: |
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| City: |
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| State: |
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| Zip: |
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| Country: |
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| Owner's
Name: |
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| Phone: |
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| Fax: |
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| Website: |
www.
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| Email: |
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Name
for UPS Shipping
(if different): |
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| UPS
Shipping Address 1: |
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| UPS
Shipping Address 2: |
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City:
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State:
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Zip:
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Country:
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Company
Form
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Sole Proprietor
Partnership
Corporation
Other:
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Date
store/gallery
was established:
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Description
of business:
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Employees
of Partners that would be
authorized to place orders:
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Drivers
License data required to accept
checks
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| Drivers
License Number: |
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| State: |
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| Expiration
date: |
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Race:
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Sex:
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Height:
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Weight:
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Eye
Color:
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Hair
Color:
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Date
of Birth:
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Documentation
Required: Photocopies
of the following items are
required to document the establishment
of a business. All documents
must be in the names and addresses
shown. Please add one item
from each section.
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Section
A: Business and or Sales Tax
Certificate
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Resale
Sales Tax Certificate |
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Business
License |
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D/B/A(Doing
Business As) Filing |
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Partnership
Filing |
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Corporate
Filing |
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Section
B: Business Checking Account
and/or Business Phone
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Checking
account in the name of the business |
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Business
Phone with Yellow Page Listing |
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Section
C: Business Stationary
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Professionally
Printed Business Card |
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Professionally
Printed Business Letterhead |
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Minimum
Opening Order:
New Customers are required
to place an initial order
of $200.00 or more.
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Business
Type:
Please check only one
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Gift
Shop |
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Gallery |
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Museum |
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Antique |
| Other
Business Type: |
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| Business
Location: |
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Annual
Sales Volume: Please
check only one
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Less
than $15,000 |
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$15,000
- $50,000 |
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Over
$50,000 |
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Number
of Employees:
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Please
check only one |
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Self
or Partner |
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2-5 |
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6-10 |
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over
10 |
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All
information supplied will
be held confidential.
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