Dealer Application

Name of Business*
Type of Business (Check all that apply)	Retail Shop Web Site Convention Mail Order Home Based
First Name of Owner*
Last Name of Owner*
Address of Business*
City*:	State: Zip:
Country*:
Shipping Address
City:	State: Zip:
Country:
Owner's Home Address
City:	State: Zip:
Country:
Business Phone*
Home Phone
Fax
Can your phone number be found in the business phone directory? Yes No
If yes, under what name?
If no, can your business phone be reached through information? Yes No
Email Address*
Web Site
State Tax Exemption #
List 3 magic companies with which you currently have wholesale accounts (fax copies of packing slips or invoices if available)
Company Company Company	How Long How Long How Long
Name on Bank Account
Bank Name and Phone #