Medicine Bow Saddlery LLC

1319 South Third Street

Laramie, WY 82072

Phone: 307-745-6135 Fax: 307-745-2069

Email: sales@medicinebowsaddlery.com

Dealer Application

Please fill in this form and submit it to us. All categories with an (*) are required.

 

* Name of Store/Catalog:
Number of Years in Business:
* Your Phone #:
Your Fax #:
* Delivery Address (Street & Number):
* Billing Address (P.O. Box):

 
* City:
* State:
* Zip:
Federal ID #:
State Tax Resale #
* Name of Purchaser:
Title:
Description of the type of business activity, or type of items generally sold by the purchaser:
* Please list 3 trade references that you currently purchase stock from:
* 1
* 2
* 3
Web Address:
* E-Mail:
 

By clicking "Submit" I hereby certify that the above information is correct. I hereby authorize the above credit references to release credit information to Medicine
Bow Saddlery.