Dealer Application

Name:   
Address:
City: State: Zip:

Home Phone: Cell Phone:
Fax: E-Mail:

How many spaces are you interested in renting? 1 2 3

Please describe the primary types of items you intend to sell:

Is this your first time as an antique dealer? No Yes If "No" and you currently have space in another shop, which shop?

Please list any physical conditions which would prevent you from helping move / load customer purchases:

Please check those days that you are available to work:
Sun     Mon     Tue     Wed     Thu     Fri     Sat