Dealer / Distributor Application

Customer Instructions

Complete the appropriate pages and fax back to above number. Include a photocopy of your Resale Card and/or Tax ID card. All applicants need to fill out completely and sign this page, Resale Card. Incomplete applications will be rejected. False and/or misleading information will subject applicant to complete account disqualification and forfeiture of any and all rights otherwise at- tendant thereto.

Business Info

Sole Proprietorship
Partnership
Corporation
If Corporation
Yes
No

References

Provide 3 personal references with phone numbers

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