Company Company Legal Name: First Name Last Name Email Street City State/Province Zip Shipping Street 1: Shipping Street 2: Shipping City: Shipping State: Shipping Postal Code: Physical Street 1: Physical Street 2: Physical City: Physical State: Physical Postal Code: Store Type: Traditional "brick and mortar" store Online store (own website) Catalog Third party e-commerce Other Business Start Date: Owner Name: Owner Phone: Owner Email: Buyer Name: Buyer Phone: Buyer Email: A/P Contact: A/P Phone: A/P Email: Preferred Email for Order Copies: Website Instagram:
