Business Information

Legal Business Name *

DBA / Store Name (if applicable)

Business Type (Gift Shop, Online Store, etc.)

Business Website URL

Street Address

City

State

ZIP Code

Country

Tax & Verification

Resale Certificate / Tax ID Number *

State Issued *

Primary Contact Information

Full Name *

Role / Title

Email Address *

Phone Number

Optional Secondary Contact

Name

Phone

Business Operations

Preferred Communication Method

Agreement & Authorization

I confirm that this is an established retail business with a valid tax ID number. *