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Mommy On The Go Diaper Bag_ LLC

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					                       Mommy On The Go Diaper Bag, LLC
                                Anaheim, CA 92807
                            www.mommyonthegobag.com
                          gabriela@mommyonthegobag.com

          New Customer Contact Information and Questionnaire

Business Name: ________________________________________

Contact Name: _________________________________________

Billing Address: ________________________________________

Shipping Address: _______________________________________
***Is ship to address residential or business? _________________

Phone #: ___________________Fax #:__________________

Email: ________________________________________________

Website Address: _______________________________________

Federal ID #: ___________ Reseller Permit #: _____________

How did you hear about us?: ______________________________

How long have you been in business?: _______________________

What do you Sell?: _____________________________________

When we have goods on promotion would you like to be notified via e-mail:
Yes or No (please circle one)

How do you sell your product and to who?: (ex. Online, boutiques, Catalog, Stand alone
stores, Chain stores?)
______________________________________________

				
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