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 _______________________

Step 2. Fill out State Resale Tax I.D. Card

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