If you are a distributor and interested in working with us, please complete the following distributor application. We will review your application and, if we wish to proceed, send you a credit application form to conduct a formal background check of your company.

Name:
Company:
Address:	Suite / Apt.:
City:	State: - AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY   Zip Code:
Phone #:
Fax #:
E-Mail:
Briefly tell us about your product(s).
How did you hear about Artisanal Imports?
Comments:
Enter the number you see in the box below: