New Dealer Application Form
G² Cue Tips USA

Dealer Application

Repairman Application

Date: ________________
Business Name: _________________________________________
Owner’s Name(s) ________________________________________
Number of Employees: ________
Mailing Address: ________________________________________________
City: _________________________________
State: _______________ Zip: ___________
Shipping Address: ______________________________________________
City: _________________________________
State: _________________ Zip: __________
Phone: (____)_________________Fax: (____)_________________
E-mail Address: _________________________________________________
Web site Address: _______________________________________________
Nature of Business:
__ Wholesale __ Retail __ Storefront __ Mail Order __ Internet
Other: (Please explain) ___________________________________________
Method of Distribution: __Catalog __Telephone __Internet
__Over the Counter __ Other _____________________________________
Store’s approximate square footage: _________________________________
Store hours of operation: __________________________________________
Years in business at this location: ___________________________________
What other brand name lines do you carry?
__________ __________ __________ __________ __________ __________

Please include a photocopy/picture of your resale license or sellers permit
along with this application. Applications without a copy of your
resale license or sellers permit will not be considered.
Customer Signature: _____________________________________________
Printed Name: __________________________________________________
Title: _________________________________________________________
Resale Certificate Number: ______________________

To Our Customers:In compliance with NYS Sales and Use Tax Laws it is necessary that we have a copy of all our customers re-sale certificates with their State Sales Tax Permit Number, and if in New York State an NYS ST-120 form to show that the merchandise has been purchased for resale.