<p>Rev 04/2013</p><p>Topps Non-Direct March 5 Hobby Store Registration Form 2013 This form should be completed by a Topps Authorized Hobby Distributor to register a Hobby Store into the Topps Primary: Non-Direct Hobby Store Database. All Hobby Stores that meet Topps Authorized Hobby StoreEffective: Requirements July 2013 - should December 2013 have this form submitted. Store Locator Database Entry Submission Instructions Form must be signed by Hobby Store owner and Distributor Owner. Only Topps Authorized Distributors may submit this form on behalf of Hobby Stores. Please type information directly into form in cells provided for Hobby Store, Owner/Manager and Distributor. Please submit: Via Email: [email protected]; with subject line: Topps Hobby Store Registration Via Fax: 425-513-9338 Via Mail: GTS Distribution 12428 Hwy 99 Ste 44 Everett WA 98204 Topps Non-Direct Hobby Store Registration Form </p><p>Distributor of Record Agreement </p><p>This confirms that the following Hobby Store meets Topps Authorized Hobby Store requirements. The store manager agrees that Topps may list this store as an Authorized Hobby Store on Topps communication, including, Topps.com. This store will be serviced (in part or in whole) by this distributor for purchasing Topps products. Please type Hobby Store Information</p><p>Store Name Address 1 Address 2 City State Zip</p><p>Store Owner/Manager</p><p>Store Owner Store Manager Store Phone Store Email</p><p>Distributor Representative Territory</p><p>Distributor Confirm: Store meets Topps Authorized Hobby Store Requirements: Brick/mortar retail establishment with valid Certificate of Resale </p><p>Distributor of Record Agreement The distributor will facilitate communication with Topps on behalf of the store to secure program information and promotional materials where applicable.</p><p>Store Consent Distributor Consent</p><p>______Owner Name Owner Name</p><p>______Owner Signature Owner Signature</p><p>______Date Date </p><p>Note: Submission on this form does not guarantee submission into the Topps HTA Program. Distributors must submit HTA Submission Form. All information contained in this form is subject to verification by Topps. Distributors may be asked to submit store photos and/or copy of Certificate of Resale.</p>