New retailer application

Store information

Store name

Legal Name

Number of Locations

Billing Address

Street 1

Street 2

City

State

Zip Code

Store Address

Check if your store address is different to your billing

Street 1

Street 2

City

Zip Code

Associated with a golf course?

Website

Do you sell products online?

Check if active on social media

Instagram link

Facebook link

Twitter link

Youtube link

Please provide more information about your store below (Which brands you carry, which product categories you carry, pertinent information about your store, and any special requests).

Store images

Please upload at least 2 store images. You can upload a zip or PDF containing multiple images.

Upload 1 Upload PDF, Word, Zip or image allowed. Max 15MB.

Additional upload Upload PDF, Word, Zip or image allowed. Max 15MB.

Contact information

Buyer’s first name

Buyer’s last name

Buyer’s phone

Alt phone

Buyer’s email

Alt email

How did you hear about Mizzen+Main?

If Other, please specify