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REGISTER FORM
 
In order to obtain full access to our website, please provide the following information:
 
  Current Minga Retailer New to Minga
Referred By: (at least one required)
Print Ad
Word of mouth
Web search
 
Sales rep
     Trade Show
Store Name (required)
Contact Name (required)
Title
 Owner Partner  
      Manager Buyer  
      Clerk Other
Shipping Address (required)
City
State
ZIP
 
Is this address: Business Residential
How many stores do you operate?
    
Billing Address
 Same as above
Web Site(optional)
Phone Numbers (at least one required)
Bus.
Hm.
Cell
Fax
Other
E-mail Address (required)
 Please send monthly product emails
Preferred method of contact (check all that apply)
Email Business Home Cell
Type of Store (check all that apply)
Fair Trade Women's Btq. Children's Btq. Toy Store
Home Decor Gift Shop Museum Zoo
University Hospital Cafe Salon
Spa Pharmacy Consignment/Re-sale Wholesale
On-line Store Other
In Business Since (MM/YY)
My business is
Year Round Seasonal
Hours of Operation (optional) Check if hours change seasonally
   
 
Mon.
AM - PM
Tue.
AM - PM
Wed.
AM - PM
Thur.
AM - PM
Fri.
AM - PM
Sat.
AM - PM
Sun.
AM - PM
 
 
 
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