Retailer Request Form


	* denotes required field Please Register My Store To Have Access To Discounted Product Pricing Store Name* Contact Name* Store Address* City* State* Zip Code* Phone Number* Fax Number (I agree to receive faxes) Email Address* Store Web Page Address Last 4 Digits of Visa/MC/Discover Credit Card That Will Be Used* Seller's Permit # (California Only) Retail Industry * Billiard Retailer Craft Retailer May we place your store(s) on our "Store Locations" website pages?* Yes No I agree to only use the discounted pricing for products intended for resale* Yes No After submitting this form, REMEMBER TO ALSO GO BACK TO THE RETAILER REGISTRATION PAGE and CLICK THE "SET UP MY ACCOUNT" LINK ! (Or just click the "My Account" tab at the top or bottom of any page.) Enter the code shown: REMEMBER TO GO BACK TO THE RETAILER REGISTRATION PAGE AND SET UP YOUR ACCOUNT. (Or you may click the "My Account" tab at the top or bottom of any page)