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 *

Store name on 3rd party selling sites

Do you participate in any Fulfillment Programs?

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

Lead Source

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