Contact Name: Business Name: Tax ID#: State Resale License #: Mailing Address: City: State: Zip Code: Country: Phone Number: Fax Number: Email Address: Comments: Type of Retail Business: Art Supplies Store Bookstore Candy Shop Children's Clothing Store College Bookstore Department Store Educational Supply Store Florist Food Store Furniture Store Garden Shop Gift Store Gourmet Store Hospital Gift Shop Hotel Shop Housewares Store Premium Company Lifestyle Store Library Mail Order Catalog Museum Store Outdoor Recreational Store School Sporting Goods Store Stationery Store Supermarket Surf Shop Toy Store Web Store Women's Clothing Store Zoo Store Other Average Annual sales Volume: under $100,000 over $100,000 Number of years in business: Less than a year: more than a year: How did you find out about us? Magazine/Newspaper Referral Search Engine Trade Show Other Do you do business on the internet? yes no, but soon will be no Crocodile Creek 1648 Lawson Street Durham, NC 27703 USA P: 919-598-8152 F: 919-598-6803 E: CustomerService@CrocodileCreek.com © 2009 Crocodile Creek, All rights reserved.