Business Contact Info

First Name

Last Name

Title

Telephone

Email

Business Info

Legal Business Name

Business Address

City

State

Zip Code

DBA if applicable)

Federal Tax ID Number

Resale Certificate / upload here:

Sales Permit / upload here:

Business License / upload here:

Form of Ownership

Sole ProprietorshipPartnershipLimited Liability CompanyCorporation

Accounts Payable

Point of Contact (POC) First Name

Last Name

Telephone

Email

FFL

Point of Contact (POC) First Name

Last Name

Title

Telephone

Email

FFL Certificate
Upload a copy of your FFL Certificate Here:

CFL/CFD Number (California Only)

Type of Store

(check all that apply) Store FrontOn-line Store

Store Front Info

Store Front Name

Store Front Address

City

State

Zip Code

Telephone

Email

Annual Gross Sales ($)

On-line Store Info

On-line Store Name

Website URL

Telephone

Email

Annual Gross Sales ($)

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