Dealer Inquiry

Store Name*

First Name*

Last Name*

Street

Street 2

City

State

Zip Code

Phone*

Fax

Email*

Music Industry Website

Music Industry Website 1

Music Industry Website 2

Non-Music Industry Website

Social Media Site 1

Social Media Site 2

Online Aliases*

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Store name on 3rd party selling sites

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Do you participate in any Fulfillment Programs?

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Store Front?

Resale Tax ID Number?

Other Wholesale companies store is doing biz with

Major product lines currently carried

KMC brand/products this store is interested in

Name and distance of nearest competitor

Years in business

Approx gross yearly sales

Floor space (sq. ft)

Pref Payment Method

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