New Customer Form - The Indie Queens

Basic Info

Account Name *

Buyer Name *

Email Address *

Phone Number *

Website Address *

store address

Address Line 1 *

Address Line 2

City *

State *

Zipcode *

billing address

Address Line 1 *

Address Line 2

City *

State *

Zipcode *

BRAND OF INTEREST *

LET'S TALK BUSINESS. COMPETITIVE BRANDS CARRIED: *

WHAT MAKES YOU A GOOD FIT TO BE A RETAILER FOR THIS BRAND? *

additional details

IF APPROVED, WHAT IS THE PROJECTED RETAIL VOLUME FOR THIS BRAND ONLY IN THE FIRST YEAR? *

Timing *

PLEASE PROVIDE YOUR UPS OR FEDEX NUMBER FOR BRAND SHIPMENTS IF APPROVED *

This will give you the best shipping rate. Enter "n/a" if not applicable.

PHOTO OF STORE INTERIOR *

Click or drag a file to this area to upload.

PHOTO OF STORE EXTERIOR *

Click or drag a file to this area to upload.

COPY OF RESALE CERTIFICATE *

Click or drag a file to this area to upload.

ANYTHING ELSE? LEAVE ADDITIONAL COMMENTS HERE:

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