Title Mr. Mrs. Ms. Other

First name*

Last name*

Company

Email*

Street

City

Province/State

Postal/Zip

Country

Phone*

Fax

Do you currently operate a business selling tea, tea accessories or gift items? Yes No

Are you planning to operate a business selling tea, tea accessories or gift items? Yes No

Are you currently a retailer of products other than tea? Yes No

What sort of business do you currently operate or plan on operating? Tea Store Tea Room Souvenir Sales Internet Tea Sales Gift Basket Bed & Breakfast, Hotel, etc. Promotional Items Restaurant Other Food Service Gift Store Other Retail - Store Other Retail - Internet

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