Please complete this form for additional information and to receive your password to enter our Bookstore.

All information will be held in the strictest confidence.

First Name*
Last Name*
Address 1
Address 2
Town
State
Zip Code
Home Phone*
Cell Phone
E-Mail*
 
* required fields
 
 
 
Are you currently in the book business?   Yes No
 
If Yes:  
1) What company do you currently work for?
All information will be held in the strictest confidence.
2) Are you currently doing Drops or Book Fairs?
 
Please list your suppliers or employment history:
 
Name Phone Number
Address Zip Code
 
Name Phone Number
Address Zip Code
 
Name Phone Number
Address Zip Code
 
 
 
Are you currently employed?   Yes No
If Yes, are you looking for a career change?   Yes No
 
Do you have a large vehicle?   Yes No
Make:    Model:  
 
Do you have a computer?   Yes No
 
Do you have a place to store products?   Yes No
If Yes, where?  
 
How do you think your credit looks? Great Good Fair Poor
 
Do you own or have you owned your own business?   Yes No
 
Do you have the desire to own your own business?   Yes No
 
Do you want to make a lot of money?   Yes No
 
What is "a lot of money"?
 
What are you currently earning per year?
 
When is the best time to call you?
 
How did you find out about us?
 



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