Retailers Wanted!

Store Name:        Contact Name:

Phone Number:    Fax Number:

Email Address:     Website:

Address Line 1:

Address Line 2:

City, State & Zip:

Location Type (Plaza, Mall, Stand Alone):

Store Category (Gift Shop, Florist, Candle):

Years in Business:How did you hear about us?

Approximate monthly order of our products?

Which of our products would you be interested in retailing?

4oz Jars Candles    8oz Jars Candles     16oz Jars Candles     Votives Candles

Floaters Candles    8oz Cube Candles   8oz Tapered Candles

24oz Tapered Candles     Holiday / Seasonal Items     Eye Pillows

Back Pillows     Neck Pillows