Up Country Home Trade Application
Company Name (*)
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DBA Name
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First Name (*)
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Last Name (*)
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Position
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Years in Business
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Address 1 (*)
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Address 2
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City (*)
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State (*)
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Zip (*)
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Phone Number (*)
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Fax
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Email Address (*)
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Website
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Business Lic. - Resale Tax Cert.
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Fax (706-216-6609) or email (info@upcountryhome.com) a copy of your State resale tax certificate.
Nature of Business (check one)








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