Authorized Dealer Application | Alan Lee Collection

Primary Contact Name: *

First and Last Name

Position at Company: *

Company Name: *

Your Company's Website:

Email: *

Validate Email: *

All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Telephone: *

Fax: *

Reseller Tax ID #: *

Billing Address

Street Address 1: *

Street Address 2:

City: *

State/Province: *

Country: *

Zipcode: *

Shipping address same as Billing?: *

Shipping Address

Street Address 1:

Street Address 2:

City:

State/Province:

Country:

Zipcode:

Username and Password

Please enter a username and password.
If you leave this area blank you will be able to login using the email you provided and a password will be assigned to you.

Create a Username:

Username and Password must be a minimum of 6 characters
Spaces are allowed; punctuation is not allowed except for periods, hyphens, and underscores.

Create a Password:

Validate your Password:

Provide a password for the new account in both fields.

Kind of Store: *

Brick and Mortar Store

Online Store

Online and Brick and Mortar

Sales Rep or Distributor

Home Based Business

Interior Designer/Event Coordinator

Briefly describe your store; products you sell and what your niche is:

(i.e. gallery, gift store, specialty store, department store, etc)

How did you hear about the Alan Lee Collection?: *

I am a current customer of the Alan Lee Collection

Trade Show

Viewing in a Store

Web Search

Word of Mouth

Please read through our Authorized Dealer Terms and Conditions by following the link below
.

I have read and agree to the Terms and Conditions: *

Agree

Disagree