Form of Business:
Proprietorship    Partnership    Corporation    Limited Liability
      Country:     State/Province:
      Tax ID / Resale Number:    

Billing Information:
      Business Name:  
      Address Line 1:  
      Address Line 2:  
      City, State, Zip:   

Ship To (If different):
      Store Name:        
      Address Line 1:  
      Address Line 2:  
      City, State, Zip:   

Business Phone:
         1-800:     Fax:

Primary Contacts:
      Owner    Manager    Buyer    Other
           Name:

     Owner    Manager    Buyer    Other
           Name:

Web Site:
E-mail:     

Primary Sales Location:
     Commercial Storefront     Residential     Internet Only

Main Product Type(s)    (1 – 3):
     Needlepoint     Cross Stitch     Knitting     Quilting
     Sewing           Other:

Professional Memberships:
     TNNA    ANG    EGA    Other:

Under Current Ownership Since: (year)
At the Current Address Since:      (year)

How Did You Discover Leigh Designs?

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