Business Legal Name
Trade Name (if any)
Address Line 1
Address Line 2
City
State
Zip Code
Country
Phone Number
Website
Tax ID#SS# (put 000 for Individual)
Shipping Account# and by whom (if you have any )
Account Type (choose one) AuthorBookStoreIndividualOrganizationSpeciality StoreWholesale
Shipping Address (if different from billing address)
Shipping Address 1
Shipping Address 2
Shipping City
Shipping State
Shipping Zip Code
Shipping Country
Contact Name
Contact Email
Contact Title/Position
Account Payable Contact Name (if any)
Account Payable Contact Email (if any)
Account Payable Title/Position (if any)
We are interested to learn more about you and appreciate if you can tell us in a few words about your focus, objectives, history and achievements:
