Consignment Application
First Name:
Last Name:
StoreName:
Email:
Website:

Please provide your Stores information:
Street:  
City:
    Zip:    State:
Phone:
   Alt Phone:   Fax:

Which best describes your store?
Video

Book

Sports

Adult
Other

What Types of adult material do you currently stock?
Video Magazines
Books None
Interested in selling our Magazines ?
Yes
No


How many videos can you display?

How did you hear about us?
         

Feel free to add any Comments:
Agreement
I have read the Consignment rules and agree to to meet them