Please Fax To: Steven Marsili Sales @ 888-314-1393
New Customer Information Sheet
Business Name: _________________________________________
Billing Address: ___________________Residence or Business:___
City: ______________________________ State : ____ Zip. ______
Phone # _______________________ Fax # ___________________
E mail Address: ________________________________________
Web Address: __________________________________________
Contact Person: ________________________________________
Business License: _________________ Resale # ______________
(Copy must be attached) (Copy must be attached)
Ship to Address
Name: ________________________________________________
Address:______________________Residence or Business_______
City: _________________________ State :_____ Zip ________
Business Type
Adult Retailer ___ Costume/Party ___ Club ___ Direct Mail ___ Home Party ___
Internet ___ Lingerie Boutique ___ Outwear ___ Other ___