Record Store Day Canada

Dealer Application

*required fields

* Company Name:

* Email:

* Verify Email:

* Contact Name:

* Phone:

* Address:

* City:

Province/State:

Country:

Do you have a physical store?:

How many locations?:(if YES for physical store)

Please list your locations:(if YES for physical store)

Do you have an on-line store?:

Web address of online shop: