| Questions marked by * are required. |
| 1. |
Company Name: *
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| 2. |
Contact Name: *
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| 3. |
Email Address: *
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| 4. |
Company Address: *
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| 5. |
City, State and Zip Code *
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| 6. |
Company Phone Number: *
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| 7. |
What is the approximate quantity of your order?: *
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| 8. |
Please tell us about your company, and how you would like to use the Patagonia co-branded gear: *
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| 9. |
Are you re-selling this gear, and to whom?: *
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| 10. |
Do you have an on-line presence? -- URL: *
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| 11. |
Do you have online retail access, either to your site or client stores (an online store)? -- If yes, please describe: *
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| 12. |
Do you want to sell these garments directly to consumers - either through a website or a retail store?: *
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| 13. |
Do you sell any un-decorated gear: *
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| 14. |
Would you like order receipts to be emailed to you? If yes, to what email address: *
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| 15. |
Do you have a resale certificate? Yes or No.
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