New Dealer Information Form

Your Details First Name     Last Name Email Address Phone (Business/Home) Phone (Cellular) Billing Address Address 1 Address 2 City    State --Select-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other... Zip Code     Country Shipping Address Address 1 Address 2 City     State --Select-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other... Zip Code     Country This Section For Baton Coaches Are you a Twirling Baton Coach? Yes No If so, where     Phone Do you give private lessons? Yes No How many students? --Select-- 1-5 6-10 11-50 51-100 100+ Who was your baton instructor? Current Baton Brand(s)? Do your students compete in contests? Local Regional USTA NBTA DMA AAU This Section For Business Owners Business Name Business Phone Number Tax Reseller ID   State --Select-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other... Do you have a storefront or studio? Storefront Studio Do you sell online? Yes No Website address Annual sales $ Briefly explain the reasons why you are interested in the Star Line Baton CO. Inc. Product Line