|
Gary Stephen
George |
DEALER APPLICATION FORM
Please print, fill out the requested information
completely and mail to
the address above to insure prompt processing of this application.
RETURN WITH PHOTOGRAPHS
(2-INSIDE OF LOCATION 1-FRONT VIEW WITH SIGNAGE)
BUSINESS NAME __________________________________________________
PHONE __________________________ FAX ___________________________
ADDRESS________________________________________________________
CITY___________________________ STATE________ ZIP________________
FEDERAL TAX I.D. #_______________________ STATE RESALE #_______________
DESCRIPTION OF BUSINESS:
(Merchandise sold, square footage, etc.)
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
OTHER ART LINES CARRIED __________________________________________
________________________________________________________________
________________________________________________________________
PUBLISHERS & ARTISTS
YOU REPRESENT OR WORK WITH
1.
_________________________________ 5. __________________________________
2.
_________________________________ 6. __________________________________
3.
_________________________________ 7. __________________________________
4.
_________________________________ 8. __________________________________
YEARS IN BUSINESS ____________
NO. OF OTHER LOCATIONS _________
Please include names,
addresses and phone numbers
1.______________________________________________________________________
2.______________________________________________________________________
3.______________________________________________________________________
4.______________________________________________________________________
MOST ACTIVE RETAIL PRINT
PRICE RANGE _________________________________
NAME OF OWNER(S) OR
AUTHORIZED OFFICER ______________________________
SIGNATURE ____________________________ DATE _______________________