Private Park New Account Registration

Please completely fill out this form and submit to join the S'more Store Program.
Once received, you will receive an enrollment kit with your customer ID number,
online login information and other details.

Private Park Registration

Contact Information

Park Name *

Shipping Address (No PO Boxes Please) *

City *

State *

Zip *

Phone *

Fax *

State Tax ID

Personnel w/ Authorization to Submit Orders

Employee #1

Email Address; Employee #1

Employee #2

Email Address; Employee #2

Retail Location Details

Retail Location Size (sq ft) *

Average Weekly Sales (US $) *

Retail Account Information

Trade Channel *

Type of Business *

How were you referred to this program?

If referred by an RA Ambassador, please include their ID #.