Retail Music Dealers Form
Please print out this form and mail it to us at the address below.
Dealer Name: _______________________
Purchasing Contact Name (if different from above): _____________________________
Store Name: ____________________________________
Address:_______________________________________
City, State, Zip: _________________________________________
Billing Address (if different from above): _________________________________
City, State, Zip: _____________________________
Phone: __(_____)______________________
Fax: __(_____)____________________
Email: ____________________________________
Web Address: ________________________________
Please list what the store sells: ___________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Please indicate if you are interested in hosting Manduca Music Publications Clinician workshops:
______ Yes
______ No
Please list three other publishers that you currently do business with. Include phone numbers or e-mail addresses if you have them:
_____________________________________________________
_____________________________________________________
_____________________________________________________
Mail to: Manduca Music Publications
861 Washington Avenue
Portland, Maine 04103-2728