Title Mr. Mrs. Ms.

First name *

Last name *

Company Name (Existing or Anticipated) *

Email *

Street *

City *

Province/State *

Postal/Zip *

Country *

Phone *

Are you planning to open a new business selling tea, tea accessories or gift items? * Yes - immediately Yes - 1 month Yes - 2-3 months Yes - 3-4 months Yes - 5 months + No

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

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

Are you planning to add tea and tea accessories to your product mix? * Yes - immediately Yes - 1 month Yes - 2-3 months Yes - 3-4 months Yes - 5 months + No

What sort of business do you currently operate or plan on operating? * Bed & Breakfast Cafe Coffee Roaster Distributor Gift Baskets Gift Store Hotel Ingredients - Manufacturing Instore Bakery & Cafe Internet Sales Personal Requirements Promotional Items Restaurant Souvenir Sales Spa & Wellness Tea Room Tea Store z-Other Food Service z-Other Manufacturing z-Other Retail - Store z-Other

Do you have a business licence number? (This could be an EIN#, Federal ID#, GST#, HST#, VAT#, Resale Licence# etc.) *
Yes No

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