Dealer Application Form

Complete this form then click on "Submit". All items with asterisk must be completed.

DEALER APPLICATION
1- Must be a Musical Instrument Retailer.
2- Must provide resale certificate or resale license.
3- Must provide 3 credit references in the music industry.
4- Must meet minimum order and annual purchase requirements.

STORE INFORMATION:

Years in Business: , Sole Proprietership, Partnership, Subchapter S Corporation, Corporation

FED ID:

ACCOUNT ADDRESS:

* Account name:

Street Address 1:

Street Address 2:

City: , State: , Zip:

* Phone: , Extension: , Fax:

Email: , Web Site:

Buyer First Name: , Buyer Last Name:

Other Authorized for Purchasing: or

Multiple Stores, Total numer of stores: , We Use Central Purchasing.

SHIP TO:

Same as above address.
Ship name:

Last name:

Street Address:

City: , State: , Zip:

Shipping- Use UPS.
Shipping- Use:

TRADE REFERENCES:

Reference 1: Phone:

Reference 2: Phone:

Reference 3: Phone:

BANK REFERENCE:

Name on Account:

Bank Name: , Branch or Address:

Account Number: , Bank Phone:

Contact:

BUSINESS or RESALE LICENSE:

IMPORTANT- California requires a signed Tax Exemption Certificate and must be on file prior to shipping orders.

State: , ID:

TYPE OF STORE: (Check all that apply)

Retail Music Store
Pawn and Music
Internet Sales Only
Retail and Internet Sales

PRODUCTS & SERVICES OFFERED:

Fretted Instruments
Drums and Percussion
Band and Orchestra
Print Music
Repairs
Recording Studio
Piano, Keyboard, Organ
Hispanic Customers
Other:

LESSONS OFFERED:

No Lessons Offered
Guitar
Banjo
Mandolin
Drum
Number of Instructors:

STORE HOURS:

Monday thru Friday, from: to: , closed

PRODUCT LINES CARRIED:

Product Line 1:

Product Line 2:

Product Line 3:

Product Line 4:

TERMS:

COD Company Check
COD Cashiers Check
Bank Card (Visa, MC, or Discover)

I hereby certify the above information is correct and authorize above references to release any and all information concerning my account.