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Contact Name: *
Email: *
Retailer Name or International Distributor: *
Account Type (Specialty Store/Boutique, E-comm, International Distributor, Other): *
Date Established: *
Business Operates As (Sole proprietorship, Partnership, Corporation, Other): *
Street Address: *
City, State, Zip Code: *
Country: *
If you have brick and mortar locations, how many and what locations: *
Please provide a link to your website: *
Please provide a link to your Instagram profile: *
Store description, baby gear you carry and your interest in WAYB: *
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