I am a current customer     (Please complete the form above the pink line.)
I would like to be a new customer     (Please complete the entire form.)
Store Name:
Address:
City:
State:
Zip:
Account requested by:
Title:
Phone No:
Fax No:
Email address:
Resale Certificate Number (Please mail or fax a photocopy of your resale certificate with this completed form.) (Not required for Alaska, New Hampshire, Montana, Oregon or Delaware) What is the physical presence of your store? (For example, street access storefront, mall/airport/hospital gift shop, home business, etc.) How long has the store been in business? What other products does your store carry? (For example, crystal, candles, flowers, etc.) Do you advertise your store or sell products using any of these methods? Fliers Newspapers Direct mail Mail order catalogs Internet sales Home shows Craft fairs or antique shows Flea markets Image Verification Please enter the text from the image [ Refresh Image ] [ What's This? ]
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