Floppy Seat

Deluxe shopping cart seat cover

Floppy Seat

Become a retailer

Thank you for your interest in the Floppy Seat®. If you would like to submit an application to become an independant retailer, please fill out this form below. We will review and get back to you as soon as we can.
* Name of applicant
* Name of business
DBA
* Length of time in business?
* Owner Name
* Business Address
Suite #
* City
* State
* Zip
* Phone
800 #

* Type of store
(if you selected other, please describe)

* Business category
(Please describe the nature of your business and the types of baby products you sell)
* Please type a UserID you will remember (for online ordering)
* Email Address
Web Address (URL)
(do not remove http://)
* Resale tax number
* Do you ship nationwide?
* Do you offer online ordering?
* How did you hear about the Floppy SeatŪ?
(if you selected other, please describe)
* Business Reference
 (1)
* Name
* Address
* Phone
* Business Reference
 (2)
* Name
* Address
* Phone
Please add additional comments here
*


I/We certity that all statements made herein are true and accurate. I/We authorize Floppy Products, Inc. to make any and all inquiries necessary of the above listed business reference relating to this application, and do grant permission to the above listed business references to release such information as may be requested by Floppy Products, Inc.

Date
Tuesday 2nd of December, 2008

*
by checking this box, you are giving your signature to this form
* title
*required information