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WHOLESALE DEALERS - Application Form

Store/Trade Name:
Official Corporate Name:
Name of Person to Contact/Owners:
Address of Outlet:
City Outlet In:
Province/State Outlet In:
Phone Number:
Fax Number:
Email Address:
Type of Business:
SQ. Footage:
# of Stores
Other Authorized Buyers:
Purchase Order Numbers Required On All Orders:     Yes / No


Invoicing Instructions
(number of copies, shop by purchase order only, mailing, authorized signature):

Country, Province or State Business Registered In:
Years In Business:
Months Of Year Open For Business:
Business License # or Tax ID #:


Comments:

   

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Toll Free 1-877-299-1340     Phone 403-245-1340     Fax 403-245-1575
110 - 8th Avenue S.W. - Main Floor Calgary, Alberta. Canada T2P 1B3
© MICAH International Ltd. 2001 ~ Native Arts and Crafts
Contact Us via email at sales@micahgallery.com