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Store Name 

How long have you been in business? *

Sales Tax Exempt # *

Please attach your tax exempt certificate *
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Where and how do you intend on selling Fancy Pants Designs Products? *

First Name *

Last Name *

Phone Number *

Mobile Phone 

How did you hear about Fancy Pants Designs? 

Street Address *

Address Line 2 

Town / City *

State & Country *

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Postcode / ZIP *