Interested in carrying koi products at your retailer locations? Please fill out the information below and we will get back to you right away!

     

    BUSINESS NAME AND ADDRESS

    store name (required)
     
    address line 1 (required)
    address line 2
     
    city (required)
    state (required)
     
    zip (required)
    country (required)
     
    Is this a commercial account?
     

    CONTACT INFORMATION

    first name (required)
    last name (required)
     
    title
    email (required)
     
    telephone
    fax
     

    BUSINESS INFORMATION

    Type of business
    Uniform StoreMedical SupplyEmbroideryGift ShopE-CommerceMobile/On SiteOther
     
    number of store locations
    number of years in business
     
    do you have a website for your business?
    if yes, what is your website's URL?
     
    do you carry inventory?
    what other lines of uniforms do you carry?
     
    where would you sell our products? (required)
    Retail store location(s)Website/Online storeCatalog salesHospital showsOther
     
    comment (required)
     
     

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