♥ COTC Publications & Products ♥

Application Form for Resellers

 

If you would like to apply to be a reseller of "Meditation for the Western World" or any of the other COTC Publications & Productions retail products, simply fill out this form and submit it. We will review your application and respond shortly.

Business & Shipping Information:

Payment Information:
(Payables Office, Include Credit Card Information for initial Orders)

Business Name: 

 Payables Contact

Address:

 Address:

Ship To:

  
City: City:
State: State:
Postal Code: Postal Code:
Country: Country:
Email: Email
 Select  Type   Sole Proprietor Corporation Other (Describe Below)
         If "Other" Please Describe
EIN or SS Phone
SAN # Fax
URL Mobile
Credit Card: Visa          MasterCard
 Discover   American Express		 C. Card #:
Expires:
Enter Items of Interest, Nature of your Business and Needs

           

 

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