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Retailer Application Form

  Retailer Application Form
   
  *Company Name:
  *First Name:
  *Last Name:
     
    BILLING ADDRESS
  *Address:
  Address2:
  *City:
  * State:
  *Postal Code:
  *Country:
  My shipping address is the same as my billing address
     
    SHIPPING ADDRESS
  Please show the following address on the Flair retailers listing Billing Address
Shipping Address
Do not show our address
  *Address:
  Address 2:
  *City:
  * State:
  *Postal Code:
  *Country:
     
    CONTACT INFO
  Do not show my phone number on the Flair Retailers listing
  *Phone:
  Fax:
     
  List my company as an online retailer on the Flair Retailers site
  Web Address:
     
  Do not show my email address on the Flair Retailers listing
  *Email Address:
  *Password:
  *Re-enter Password:
     
    BUSINESS INFO
  Primary Business:
(select the one that most applies)
  Type of Business: Sole Proprietorship
Partnership
Corporation - State of:
  # of Years in Business:
  Tax ID #:
  Preferred Method of Billing:
 Charge Card
   
     
 

 

 
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