RI Antiques Mall

Application Form

Please tell us about yourself:
Name:	*
Address:	*
	*
Phone Number:	*
Cell Phone:
E-mail Address:	*
	* = required

I am a (select one):

Full Time Dealer Part Time Dealer

I've been selling antiques for (select one):

Less than 1 year 1 to 5 years 5 to 10 years 10 to 20 years More than 20 years

I've have sold antiques in this many other shops, group shops and/or malls (select one):

None 1-2 3-5 6-10 More than 10

I am currently selling antiques in this many other shops, group shops and/or malls (select one):

None 1-2 3-5 6-10 More than 10

My average monthly sales per store in other stores is (select one):

Less than $500 $500 to $1000 $1000 to $2500 $2500 to $5000 Over $5000

I plan to do the following once I join RIAM (select one):

Make RIAM my only sales venue Sell in RIAM and other stores

I am interested in the following types of space (check all that apply):
Open Floor Space	Locked Showcase	Wall Space (artwork)
Partial Wall Stall	Jewelry Case	Galley Space (full room)
Full Ht. Wall Booth	Shelf Space	Other (Specify)

I am interested in the following booth numbers:

My areas of specialty include (check "General Merchandise" or only true specialties):
General Merchandise	Art Deco	Art	Home Accessories
Primitive/Country	50's/Retro	Pottery	Lighting
1700's-1800's Formal	60's-80's	Jewelry	Outdoor Items
Victorian	Modernism	Furniture	Architectural
Art Nouveau	Orientalia	Glassware	Toys/Dolls
Mission/Arts & Crafts	European/Classical	Collectiblies	Coins/Stamps
Other(s)List: