Consignment Application
First Name:
Last Name:
StoreName:
Email:
Website:
Please provide your Stores information:
Street:
City:
Zip:
State:
Please Select
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Other...
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?
Please Select
Under 100
100 - 200
200 - 400
400 - 600
600 - 800
800 - 1,000
Over 1,000
How did you hear about us?
Please Select
Direct Mail
Email
Banner Ad
WebSite Referal
Other
Feel free to add any Comments:
Agreement
I have read,understand and agree to the terms mentioned on the Consignment agreement page. I also understand while that page summerizes and explains the terms, business plan, expectations, my envolvement, and the rules wherein, I further understand the Consignment agreement page is NOT the actual "Consignment Agreement". Which I shall recieve upon approval of the "Consignment Form application" Upon submitting this form I agree to accept the "Consignment Agreement" for review, for which I intend to return signed, and begin to participate in the L.Scott Sales consignment program. My location has and will make arrangments to display and hold in inventory L.Scott Sales material for which I accept full responsibility. L.Scott Sales is authorized to contact me reguarding this agreement.
I have read the Consignment rules and agree to to meet them