BMD Producer & Seller Profile Application Form "*" indicates required fields Company/Organization Name* For Internal Use...First Name* Last Name* Your Title* Email Address* Are you authorized to submit this application*SelectYesNoSelectWe will contact you... Is the company or organization registered with SDAT to do business in Maryland*SelectYesNoSelectYou may continue if you would like for us to contact you... For Internal Use, Contact Person's Info if Different…First Name (If Different) Last Name (If Different) Title (If Different) Email Address (If Different) Phone NumberContact Person's…Address Line 1* Address Line 2 (If Applicable) Address Line 3 (If Applicable) Town or City* State* Zip Code* For Directory Listing & Promotions (If different, complete all that apply)Company's/Organization's Phone NumberCompany's/Organization's Email Address Address Line 1 Address Line 2 (If Applicable) Address Line 3 (If Applicable) Town or City* State* Zip Code* Website Address URL Shopping Information URL* Ecommerce URL (If Different) Facebook Page Instagram Page LinkedIn Page X Page Pinterest Page YouTube Briefly describe your business/organization and the Maryland-made consumer products that you make or sell. If you are a business or trade organization that provides a physical sales space or digital sales platform, respond for your organization and about the types of Maryland-made consumer products sold by your members/clients/constituents.*0 of 1400 max charactersOur Maryland-made products include (briefly cite types of products in list form)*0 of 1400 max charactersKey Words (Up to 100 Words, separating by commas)*0 of 500 max charactersWe sell in/on (select all that apply)*EcommerceOur StoreMaryland Specialty ShopsBoutiquesDepartment StoresGrocersDealersArts & Entertainment DistrictsMaryland Main StreetsMaryland Farmers Markets, Festivals or FairsOtherSpecify* We are a (select all that apply)*Consumer Product RetailerConsumer Product WholesalerManufacturerMakerArtistCrafts PersonAgribusinessOtherSpecify* We make or sell consumer (select all that apply)*Apparel, Accessories & ShoesJewelryArtworkCrafted ProductsCards, Stationery & LiteratureBaked GoodsMeats, Poultry & Seafood ProductsCondiments, Spices, SaucesDairy ProductsBeveragesBeauty & Personal Care ProductsHealth & Pharmaceutical ProductsMedical DevicesHousehold ProductsHome Improvement ProductsElectronics & AppliancesSports & Entertainment ProductsMusical InstrumentsOtherSpecify* We are affiliated with (Select all that apply)*Maryland With PrideMaryland Main Street ProgramMaryland Arts & Entrtainment DistrictMaryland's Best ProgramRegional Manufacturing Institute of MarylandOther Affiliation(s)Specify Main Street*Main Street Maryland CommunitiesBaltimore City Main StreetsMain Street Maryland Communities (specify)*Aberdeen Main StreetAnnapolis Main StreetBelair Main StreetBerlin Main StreetBerlin Main StreetBrunswick Main StreetCambridge Main StreetCenterville Main StreetChestertown Main StreetCumberland Main StreetDenton Main StreetDundalk Main StreetEaston Main StreetElkton Main StreetEllicott City Main StreetFrederick Main StreetFrederick Main StreetFrostburg Main StreetHagerstown Main StreetHave de Grace Main StreetHave de Grace Main StreetLaurel Main StreetLeonardtown Main StreetMain Street MarylandMiddletown Main StreetMount Airy Main StreetNew Market Main StreetOakland Main StreetOcean City Main StreetPrincess Anne Main StreetReisterstown Main StreetSalisbury Main StreetSalisbury Main StreetSykesville Main StreetTakoma Park Main StreetTaneytown Main StreetThurmont Main StreetWestminster Main StreetWilliamsport Main StreetAberdeen Main StreetBaltimore City Main Streets (specify)*Belair-Edison Main StreetFells Point Main StreetHamilton Lauraville Main StreetHighlandtown Main StreetFederal Hill Main StreetPark Heights Main StreetPennsylvania Avenue Main StreetPigtown Main StreetWaverly Main StreetBelair-Edison Main StreetOther Affiliation(s) (specify)* ImagesEnter up to three imagesImage 1 (Logo preferred)*Accepted file types: jpg, jpeg, png, Max. file size: 5 MB.Image 2Accepted file types: jpg, jpeg, png, Max. file size: 5 MB.Image 3Accepted file types: jpg, jpeg, png, Max. file size: 5 MB.
