Bookstore Physical Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name *

We need the name of the primary store contact person

First Name

Last Name

Phone

(###)

###

####

Is your store currently a New York Times Bestsellers reporting store? *

Please note this doesn't automatically exclude one from consideration though reporting stores will receive priority consideration

Yes

Not At This Time

Does your store currently have an established account with Harper Collins Publishing? *

Please note that this doesn't automatically exclude one from consideration though stores with an existing account with Harper Collins Publishing will receive priority consideration

YES

NOT AT THIS TIME

By checking this box you are confirming that the bookstore listed in this submission, is a physical, brick-and-mortar bookstore *

yes

By checking this box you agree to the understanding that reporting to New York Times Bestsellers list and having a Harper Collins Publishing account will be required to participate in this opportunity. If you do not currently have these prerequisites established, information on how to establish these accounts will be provided to you, if necessary. *

YES I UNDERSTAND

If selected as a participating bookstore, you give permission for NAB2 to use your name, image and likeness in any communications pertaining to the book buy *

I AGREE