1250 Blosser Lane
Willits, California 95490 USA
For Orders:1-800-726-8032
FAX 1-707-459-0261
ancient@pacific.net
To receive a retail catalog
please send $3.00 to the above address

Wholesale Catalog Request Form

The Ancient Circles/Open Circles Distributors Wholesale Catalog is sent by MAIL ONLY.
Before we can send it, we need the following information:

Boxes with * are required.

*I have read and agree to the Wholesale Terms and Conditions — yes     no

*Business Name:

*State Sales Tax Number:

*Contact Name:

*Email Address:

*Mailing Address:

*City:
*State    * Zip

Country: (If other than US)

*Daytime Phone:

Shipping Address:
(if different than above)

City:
     State:      Zip

Country:
(If other than US)

Where do you sell? Check all that apply.

*Shop or Storefront: Yes   or No      Shows:      WebSite:
If you have a web site, where is your domain? http://
Internet Auctions:      Mail Order      Home:       Other:

If other, where?

How did you here about us?

Thank you. We will be contacting you soon.

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All Rights Reserved © 1996 Ann W. Weller
No portion of this publication may be reproduced or transmittedin any form or by any means, electronic or mechanical,
including by photocopying, recording, scanning, or use of any information storage and retrieval system
without express written permission from Ann W. Weller, Proprietor, Ancient Circles.

*I have read and agree to the Wholesale Terms and Conditions — yes no
*Business Name:
*State Sales Tax Number:
*Contact Name:
*Email Address:
*Mailing Address:
*City:	State Zip
Country:	(If other than US)
*Daytime Phone:

Shipping Address:	(if different than above)
City:	State: Zip
Country:	(If other than US)

Where do you sell? Check all that apply.
*Shop or Storefront: Yes or No Shows: WebSite: If you have a web site, where is your domain? http:// Internet Auctions: Mail Order Home: Other:
If other, where?
How did you here about us?