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	REGISTRATION Thank you for your interest in Susan Farber Collections, Inc. Please fill out this form and we will process your request as soon as possible. Please expect an e-mail response from us shortly.
	First Name: *
	Last Name: *
	Store Name: *
	Address: *
	City: *
	State:
	Zip: *
	Country:
	Phone: *
	Fax: *
	Email: *
	Resale#: *

	What clothing lines do you carry? (please list 3-5): *


	What accessory lines do you carry? (please list 3-5): *


	What is the nature of your business? (please check only one): *
		Clothing
		Shoes
		Accessories
		Jewlery
		Home Accessories
		Salon/Spa
		Other (please explain):

	(Wholesale pricelist is only available to those who provide a Resale#:)
		Pricelist Request
		Call Back Request
	Comments/Inquiry:
	* Denotes a required field