Become an Authorized Lake George Chart Vendor

I/we are requesting to become an Authorized Lake George Chart Vendor and are providing the following information for your review and file. The Lake George Power Squadron does not sell or distribute any information collected from our vendors and ONLY sells navigation charts wholesale. All information is kept strictly confidential.

Company Name:
Order Contact Name:
Billing Contact Name:
Billing Email:
Billing Address:
Shipping Address:
Telephone Number:
Fax Number:
NYS Tax ID Number/EIN:

By submitting this form to the Lake George Power Squadron, I am acting on behalf of the company requesting to become an Authorized Lake George Chart Vendor. I further grant permission to the Lake George Power Squadron to advertise to the general public my retail business location.

Authorized signature:________________________________

Mail this form and a copy of businesses tax certificate
to
Lake George Power Squadron
P.O. Box 411
Burnt Hills, NY 12027

NOTE: Vendors will be contacted with 14 days of receipt of the form and documentation of approval or if additional information is required.