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  e-mail address -
  
  Contact Name -
  
  Company Name
  
  Address (Street)
  
  Address (Mailing, if different)
  
  City                                                                 Prov/State    P/Code
              
  Telephone                      Fax
              

  Type of Business (Please check any that apply) -

      Gift Shop   Souvenir Shop  Trading Post   Seasonal  
      Major Retailer   Jr. Dept. Store   Bingo Hall  Other 

   How did you hear about us? -

      I'm Already a Customer  Referral  Trade Show
      Web Search  Sales Rep.  Other

   Please send me updates and newsletters by e-mail  -   Yes   No 

   Please call me by telephone to discuss options -  Yes   No 

   Notes