Sheet1 - Pixie Mood

							                                       Pixie Mood
                                    Registration Form
*Fields marked with an asterisk (*) are mandatory.
*Company Name:
*Contact Name:
*Business Registration #:
Vendors Permit #/PST # (Only
applicable to Canada):
Business Type:                    Please choose…
*Address:
*Phone:
Fax:
*Email:
Website:
Years in business:
Prodcuts and brands carried:
Additional Comments:




        Please kindly complete the above form and email this form back to us at
                          sales@pixiemood.com. Thank you.




                                                             Please choose…
                                                             Online store
                                                             Boutique
                                                             Booth at Shopping Center
                                                             Department Store
   Pixie Mood
Registration Form