Application form for new dealership..........

Today is:
Have you ever purchased from Canvas Emporium before? Yes No
If so, under what name?

Business Name:
Check One:	Corporation Partnership Proprietorship Limited Liability Company
Address:
City:
County:
State:
Zip:
Business Telephone:
Fax:
Email:
Year Established:

Premises:	Owned Leased

Name of Principal(s):
Address
City
State
Zip
Home Telephone

If premises are leased, name and address of Lessor:
Name:
Address:
City:
State:
Zip:

Your Bank (Business Account):
Account #:
Bank Address:

City:
State:
Zip: