Boat Blossums Reseller Account Application

Please fax or mail a copy of your current year sales tax certificate for our records. Blanket sales tax certificates are no longer accepted.

Fields marked with an asterisk * are required.

First Name:	*
Last Name:	*
Business Name:	*
Address1:	*
Address2:
City:	*
State:	*
ZIP Code:	*
Country:	*
Phone:	*
Fax:
Email:	*
Type of Business:	*
Responsible Party:	*
	Please remember to fax or mail a copy of your current year sales tax certificate for our records.