Retailer Inquiry  
 
Contact Information
First Name*
 
 
Last Name*
 
 
 
Email*
 
 
Phone Number*
 
 
 
 
Company Information
Store Name*
 
 
 
Main Store Address*
 
 
City*
 
 
 
State*
 
 
Zip*
 
 
 
Number of years in business*
 
 
Number of Retail Stores*
 
 
 
Average annual sales*
 
 
 
 
How did you hear about INFRA?*
 
 
 
 
Why are you interested in joining INFRA?*