REGISTRATION FORM

This form is for Retailers only. The purpose of this form is to serve our customers better and to make it possible to provide our retailers with information via e-mail.

Please note, the fields with an * are required fields

Please provide us with the following information. Thank you.

Date
Company *
Buyer's Name *
Title
Address *
Address (Continued)
City *
State *
Zip Code *
Country
Phone Number *
Fax Number
E-mail address *
Website address
Business Tax Number or Federal ID
Type of Business (Choose from List) *
Are you a current customer?
Yes No
Are you interested in receiving our seasonal catalogs?
Yes No
Do you want to receive notification of new products, seasonal features, and special offers via e-mail?
Yes No
How do you know about us?
Would you be interested in placing orders on line?
Yes No
Do you feature India Tree Products on your web site?
Yes No
If not, do you plan on featuring India Tree products on your web site in the future?
Yes No
Do you have suggestions of specific information to feature for your customers on the India Tree Web site?
If we had a special web site for Retailers Only, what type of information would you like to see in that section?

Copyright © 2002-2008 Gretchen Goehrend & Associates, Inc.
800 369 4848
206 270 0293
206 282 0587
india@indiatree.com