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Basic Info
Account Name
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Buyer Name
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Email Address
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Phone Number
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Website Address
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store address
Address Line 1
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Address Line 2
City
*
State
*
Zipcode
*
billing address
Address Line 1
*
Address Line 2
City
*
State
*
Zipcode
*
BRAND OF INTEREST
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Select a brand...
Augustinus Bader
Dr. Barbara Sturm
Westman Atelier
LET'S TALK BUSINESS. COMPETITIVE BRANDS CARRIED:
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WHAT MAKES YOU A GOOD FIT TO BE A RETAILER FOR THIS BRAND?
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additional details
IF APPROVED, WHAT IS THE PROJECTED RETAIL VOLUME FOR THIS BRAND ONLY IN THE FIRST YEAR?
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Timing
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Timing
Now
Within a Month
6 Months
Next Year
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
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PHOTO OF STORE EXTERIOR
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COPY OF RESALE CERTIFICATE
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ANYTHING ELSE? LEAVE ADDITIONAL COMMENTS HERE:
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