Affiliate and Wholesale Customer Application

Affiliate & Customer Information

Store Information:
Store Name:
Contact:
Address:
City:
State:	Zip:
Phone:	Fax:
Email:
Type of Business: Sole Proprietorship Partnership Corporation If Corporation: State of Incorporation: Year of Incorporation:
Owners/Partners:
Name:
Address:
Name:
Address:
Officers:
Name:
Title:
Address:
Name:
Title:
Address:
Name:
Title:
Address:
Name:
Title:
Address:
Questionnaire:
Do you sell from other locations? Yes No
If yes, please enter names and addresses of other locations:
How long have you been in business?
Do you sell clothing? Yes No
If yes, please enter the brand names of the clothing you sell:
Do you currently sell polo equipment? Yes No
If yes, please enter the lines of the polo equipment you sell:
When would you want delivery of your initial order?
What products do you want in your initial order?
What dollar amount do you anticipate as an initial order?
Will you be using purchase order# resale certificate # . (A copy of the resale certificate must be faxed to 1-561-795-1731 to complete processing of this application.)
Please provide 5 supplier's references:
Name: Address: Phone: Fax:
Name: Address: Phone: Fax:
Name: Address: Phone: Fax:
Name: Address: Phone: Fax:
Name: Address: Phone: Fax: