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Business information
Company Name
Do you have a business license?
Yes
No
Type of business
Record store
Book store
Online store / eCommerce
Wholesale
Retail chain
Other retailer (Clothing, eletronics, gifts/toys, restaurant
Other
Specialty / comment
Number of locations
Contact information
First Name
Last Name
Position/Title
Email
Phone Number
Street Address
Address 2
City
State
Zip Code
Password
Confirm password
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