Dal Negro - Tradition and Technology United

Customer Service: 1.888.765.3740

Wholesale Inquiries: 1.888.8.DALNEGRO

INFORMATION

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Dal Negro Cards

Casino Cards

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Retailer Application

Please fill out the following application. You will be contacted via email with the status of your application.

* indicates that the field is required.

Username:	*
Password:	* (6-12 chars)
Retype:	*

Email:	* (eg. info@dalnegrocards.com)
Phone:	(eg. 317-555-1212)
Website (if any):	(eg. www.mysite.com)
Mailing Address:

Contact Name:	*
Business Name:	*
State Tax Id or SSN:
Current DalNegro Distributor (if any):
How long have you been in business?
	Under 1 year 1-2 Years 3-5 Years 5+ Years
What type of business do you have?
	Retail Storefront Online Store Gaming Club Other
How do you intend on selling the cards?
Do you already have an existing account with DalNegroCards? (now applying for online account)
	No Yes
Additional Comments: