Today’s Date:_______________________

Your Name: __________________________________________________________________________

Company Name (if any): __________________________________________________________________________

Mailing Address: _______________________________________________________________________

City: _____________________________________ State: _________________ Zip: _________________

Day Phone: ____________________________________________

Evening Phone: _________________________________________

E-mail Address: ________________________________________________

Brief Description of Merchandise: __________________________________________________________

_____________________________________________________________

_____________________________________________________________

Booth Size Desired: _______x_________ or ________x________ or ________x_________   (example: 4' wide x 2' deep)
______________________________________________________________

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Place a check mark in the one or more Quilted Bear stores are you interested in joining.

MAKE SURE YOU INCLUDE AT LEAST ONE PICTURE FOR EACH STORE YOU WOULD LIKE TO JOIN.

(       ) Las Vegas, NV
(       ) Provo, UT
(       ) Ogden, UT
(       ) Midvale, UT
(       ) Mesa, AZ

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(       ) I will personally decorate my Booth.     (       ) I would like the Store to decorate my Booth (With items I provide).

(       ) I will personally restock my Booth.        (       ) I will ship merchandise for Store to Restock.