Stoner Trivia, A Trivia Card Game-Reseller's Form

Reseller's Form

(Please contact us for Reseller Rates-sales@stonertrivia.com )

Retailer Order Form for the Re-sale of Stoner Trivia, A Trivia Card Game

Please fill out the information requested below and return your order form to us by mail or fax at:

P.O. Box 25 Langhorne, PA 19047

Toll Free Phone#: (800) 213-7234 Fax #: ( 847) 750-0659

(Please Print Clearly)

Date: ___/___/___

Retailer/Store Name : ___________________________________________________

Retailer Store Address :

_________________________________________________ _________________________________________________ _________________________________________________

Business Phone #: ____________________________________________________

Email Address if available : ______________________________________________

Authorized Retail Buyer:________________________________________________

Authorized Buyer Signature: ____________________________________________

# of Cases Requesting: (12 units to a case): ______________________________

Retailer Shipping Address : (if different from store location)

____________________________________________ ____________________________________________ ____________________________________________