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Dealer Application to Purchase Products online * Required Fields
First Name*		Last Name*
Company Name*
SSN or Federal Tax ID*
Billing Address*
City*		State*
Zip*		Other State:
Country*
Phone Number*		Fax Number
E-Mail*		Web Address
At present location since (date)*		Year Established*
Year Incorporated*		Which state?*
Resale Number*
Annual Sales
Business References:
Name*		Acct #*
Address*
City*		State*
Zip*
Phone Number*		Fax Number

Name*		Acct #*
Address*
City*		State*
Zip*
Phone Number*		Fax Number

Bank*		Authorized Signer
Contact*		SSN
Bank Account No.		Drivers License #
Phone		State
I want to be contacted regarding my dealer relationship.
I want to receive newsletters on specials, updates and events.
Website Login Info
User ID*	Must be between 5-10 characters (no spaces or special characters)
Password*	Must be between 5-10 characters (no spaces or special characters)
Retype-Password*
If company check approval is granted, I hereby personally guarantee the payment of all obligations of the aforementioned corporation until withdrawn by me by certified mail notice. I understand a finance charge of 1.5% per month, annual percentage rate of 18% is applied to returned checks after 30 days. Also, if my account must be placed in the hands of an attorney for collection, or if collection is made through bankruptcy or probate proceedings, I do agree to pay attorney's fees and court costs so incurred by Performance Depot, Inc. All charges are due and payable in full to Performance Depot, Inc. I understand that acceptance of this application is granted only for as long as this account is in good standing.


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