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General Information (* is required): Company Name *: Contact Name *: Phone Number *: Fax Number: Website Address (no "http" please): Email Address *: Business Address *: City *: State *: - Select One - Not in the USA Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam 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 Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip Code *: Country *: - Select One - United States Canada Mexico Other Country If other, please list: Retailer Category *: - Select One - Catalog Internet based Retail Store -- Patio/Casual Furniture Retail Store -- Hearth/Fireplace Retail Store -- Pool/Spa Retail Store -- Nursery Retail Store -- Distributor Retail Store -- Other Have you ever sold hammocks before? If so, what brand? Do you currently sell hammocks? If so, what brand? The following section is OPTIONAL Secondary Address (shipping address if different from above): Billing Address: City: State: - Select One - Not in the USA Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam 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 Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip Code: Country - Select One - United States Canada Mexico Other Country If other, please list:
General Information (* is required): Company Name *: Contact Name *: Phone Number *: Fax Number: Website Address (no "http" please): Email Address *: Business Address *: City *: State *: - Select One - Not in the USA Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam 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 Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip Code *: Country *: - Select One - United States Canada Mexico Other Country If other, please list: Retailer Category *: - Select One - Catalog Internet based Retail Store -- Patio/Casual Furniture Retail Store -- Hearth/Fireplace Retail Store -- Pool/Spa Retail Store -- Nursery Retail Store -- Distributor Retail Store -- Other Have you ever sold hammocks before? If so, what brand? Do you currently sell hammocks? If so, what brand?
The following section is OPTIONAL
Secondary Address (shipping address if different from above): Billing Address: City: State: - Select One - Not in the USA Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam 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 Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip Code: Country - Select One - United States Canada Mexico Other Country If other, please list:
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Unique Simplicities, Inc., 93 Anderson Road, Gardiner, New York 12525-5608Phone: (800) 845-1119 - Fax: (845) 895-1933 - info@ushammocks.com
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