CUSTOMER INFORMATION

* First Name:

* Last Name:

* Company Name:

* Street Address:

* City:

* State:

* ZIP/Postal Code:

* Office Phone:

Cell:

Fax:

* Email:

Website:

ADDITIONAL INFORMATION

What retail price points do you carry in your store?  to

Who is your customer base?

What are the top three brands that you carry?

What category do you need?

How many stores do you have?

How long have you owned your store?

Which markets do you attend?

Do you carry accessories? Yes No

Have you done any buying at the San Pedro mart? Yes No