Retailer Form for Fascinations Unique Toys Holiday Gifts Birthday Gifts and Physics Gifts


To receive a dealer information kit, please submit the following form. Please fill out the form completely. Items with an "" are Mandatory. Please also fax your business or resale license (with tax ID#) Fax to: 206-870-3004 - Attention: Sales Thank You.*

Name Information
*Company Name:
*Company dba Name:
Business License Information
*Resale License #:
or UBI #:
Business Type (check all that apply)
Retail Store: Catalog: Website: Other:
If "Other" is checked, describe here:
Business Description:
Target Market
Promotional: Events: Specialty Consumer: Educational: Other:
If "Other" is checked, describe here:
Bill To Information
*Address:
*City:
*State:		*Zip:
*Country:
Ship To Information
*Address:
*City:
*State:		*Zip:
*Country:
Contact Information
*First Name:
*Last Name:
*Daytime Phone:
*Email Address:
*Confirm Email:

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Retailer Information and Application