Storms Publishing Authorized Dealer Application Form

Authorized Dealer Application Form
Date

MonthDayYear
Business Name
DBA
Full Name*

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Fax Number

Area CodePhone Number
E-mail*
Website Address
EIN
Resale Permit #
Hours of operation
Number of sales people
Years in Business
Annual revenue
Price Range
Territory
Type of Business
Contact Person
Owner's Name

First NameLast Name
Owner's Phone Number

Area CodePhone Number
Owner's Email address
Gallery Director Name

First NameLast Name
Gallery Director Phone Number

Area CodePhone Number
Gallery Director Email address
Name of artists currently been represented by Gallery
Name of best selling artist
Please state how do you plan to market and promote our artwork
Please list the trade shows your company attends each year
Specific Application Requests/Details
Should be Empty: