VENDOR FORM

Name of Company:		*Required
City:
Address:
Province/State:
Country:	Canada United States
PostalCode/Zip:
Tel.:		*Required
Fax:
E-mail:		*Required
How did you hear about our products?:
Contact Person:		*Required
Sales Identification number:
Number of years in business:
How do you plan on selling / distributing Luna International products?
Retail Store:	Yes No	*Required
If "Yes", what type of:	Clothing Furniture Toys Other
If "Yes" Name of Catalogue:
internet:
If "Yes" Name of Catalogue:
If "Yes" Website:
Specify Other: