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*Required Fields

First Name:
Last Name:
Company Name: 
Company Address: 
ZIP/Postal Code:
Tax I.D. # :
(Required for U.S. Businesses)
Business Phone:
  Business Fax:
E-Mail Address:
Owner's Name:
Manager's Name:

* My primary balloon distributor is

* Primary Business Type
Balloon Professional
Balloon Twister
Party/Novelty Store
Party Rental
Card or Gift Shop
Gift Baskets
Discount Store
Drug Store
Craft/Hobby Store
Event/Party Planner
Wedding Planner
Event Site/Venue (where events are held)

* Store Type
Independent Storefront
Chain/Franchise Storefront
Warehouse (No Walk-In)

* Services Offered (Check ALL that apply.)
Balloon Decorating Onsite
Balloon Decor For Pick Up
Event Planning
Custom Bouquets Delivered
Custom Bouquets for Pick Up
Single Inflated Balloons for Pick Up
Balloon Twisting/Entertaining
Gift Baskets
Gift In A Balloon

* Products Offered and Used(Check ALL that apply.)
Latex Balloons
Foil Balloons
Entertainer/Twisting Balloons
Personalized Balloons (such as JUST WRITE)
SDS Panels
Consumer Packaged Balloons
Balloon Twisting Kits
Licensed Characters
Water Balloons

* Interest
I DO or am interested in doing hands-on professional balloon work (decor, delivery, pick up, entertainment) for sale.
I DO NOT do hands-on professional balloon work for resale but SELL, OR AM INTERESTED IN SELLING, packaged balloons at retail.
I DO NOT do hands-on professional balloon work for resale but am INTERESTED IN BUYING balloon decor and/or balloon deliveries.
None of the above. My interest in Qualatex products is:

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Pioneer Balloon Company Privacy Statement

The following designs and marks are owned by Pioneer® Balloon Company, unless otherwise indicated. ©PBC. All rights reserved. Angel Sheer™, Balloon Magic®, BalloonRibbon™, Bubble Ballon®, CBA®, Certified Balloon Artist™, Clip ‘n Stick™, Color Curls™, Connect-A-Dot™, Crystal™, Crystalgraphic™, Design-A-Round™, Diamond Expressions™, DimensionAir™, Float Note™, Funsational®, GEO®, GEO Blossom®, GEO Donut®, GlitterPrint™, GloPrint™, IMPRESS II®, IMPRESS V™, IncrediBow™, JUST WRITE™, Message-A-Round™, Microclear™, Microfoil®, Milori™, PartyMate™, Pioneer®, QBN®, Qualatex®, Qualatex Balloon Network®, Qualatex MasterBow®, Qualatex Quick Link Balloons™, ProSizer™, Sparkle™ Products, Spinner™ Balloon Patent Pending, QuikClip™, Quickie Clips®, QuikFrame™, SDS™, Signature Series™, SportsBall™, SuperAgate®, SuperScript™, Suprafoil™, The Very Best™, Thought Bubble®, TopPrint™, and Twinklers™.

Single Bubbles and Deco Bubbles are protected by U.S. Patent No. 6,782,675. Double Bubbles are protected by U.S. Patent No. 6,782,675, No. 6,758,715.
Bubble Shape are protected by U.S. Patent No. 7,121,915

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