Print this page, fill in information, and send to us!
If you are interested in applying for credit please fill in upper & lower portion of form and fax it to the number listed below.
Email me for a copy of the Wholesale Order Form in PDF format.
Business name______________________________________
Address___________________________________________
City, State, Zip_____________________________________
Phone #___________________________________________
Fax #_____________________________________________
E-mail address_____________________________________
Contact person_____________________________________
# of years in business________________________________
Type of business____________________________________
What brand (s) of machines do you sell?
_________________________________________________
Sales Tax ID#______________________________________
Number of yeas in business___________________________
Bank name________________________________________
Bank Checking Account #____________________________
Bank address______________________________________
Bank phone #______________________________________
Bank contact person_________________________________
Dunn & Bradstreet Acct.#____________________________
Please included 3 trade references with whom you have open credit.
Include: Business name, address, phone, fax, and acct. #'s.
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