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Company name: *

Street address: *

City: *

State / province:

Zip / postal code: *

Same as Physical Address:

Mailing Address

Mailing Address: *

City: *

State: *

ZipCode: *

Buyer Information

Buyer email address will be used for all email communication

First name: *

Last name: *

Phone:

Email: *

Owner Information

Owner's First Name: *

Owner's Last Name: *

Owner Phone Number: *

Owner's Email: *

License information

FFL#:

Expiration Date:

FFL Document:

SOTNumber:

SOT Year:

SOT Document:

Federal Tax ID:

Federal Tax Document:

Business Information

Year In Business: *

Opening Hour: AM

Closing Hour: PM

Retail Square Footage:

Manufacturing Square Footage:

Average # of firearms in inventory:

Website Address:

Do you sell firearms on the Internet?:

Yes
No

*

Percent of total sales (Must total 100%)

Store:

Internet:

Do you sell firearms on Gunbroker?:

Yes
No

*

Estimated percent of sales on Gunbroker:

Estimated annual purchases from MSR Distribution:

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Username: *

Password: *

Confirm password: *

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Mailing Address

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Owner Information

License information

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