Dealer Application
CONTACT INFO
Your Name
Your E-mail
DEALER INFO
Name
Company
Address
City
State
Zip
Phone
Cell phone
Fax
E-mail
BILLING INFO
Contact Name
Billing Address
City
State
Zip
Contact Phone
Fax
Federal Tax ID #
Years in Business
Have you, or a business controlled by you, ever declared bankruptcy?
yes:
no:
TRADE REFERENCES
Company
Phone
Account #
Years Acct.
Established
Company
Phone
Account #
Years Acct.
Established
(Required) Monthly Shutter Volume
'
Installation services needed?
yes:
no:
TERMS AND CONDITIONS
(please read
link
)
AGREEMENT
I,
,
,
,
hereby certify all information is correct.
Tel: 1 (804) 752 · 0045 | Fax: 1 (804) 752 · 0046 | E-mail: info@classicwindowfurniture.com | www.classicwindowfurniture.com | © 2008
