Authorized Dealer Form 2021

Business Name *

Contact Name *

Street Address *

Street Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address

Description of product/service being displayed *

Please list your sites *

Package Selection

We allow companies to purchase one of the following license good for one year upon approval:

* Authorized dealer (must purchase all items with ALPHA OMEGA THETA SORORITY INC trademarks from an ALPHA OMEGA THETA SORORITY INC licensed manufacturer and/or sells general ALPHA OMEGA THETA SORORITY INC items)

*Self-Manufacturer (May produce items themselves with ALPHA OMEGA THETA SORORITY INC trademarks as well as get items with ALPHA OMEGA THETA SORORITY INC trademarks from an ALPHA OMEGA THETA SORORITY INC licensed manufacturer and/or sell general items)

* Manufacturing authorized dealer (May produce and sell ALPHA OMEGA THETA SORORITY INC items for resale and wholesale as well as sell items themselves at events)

* Manufacturer ONLY (May produce and sell ALPHA OMEGA THETA SORORITY INC items for resale and wholesale but not vend at events.

Dealer Options *

Self-Manufacturer Authorized dealer Manufacturing authorized dealer Manufacturer ONLY

If you participated last year and would like to retain the same Dealer License, please list it below.

Dealers Number

Signature *

Clear