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Custom AV Integrators
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Arcadia Motorized
Outdoor Shades
Exterior Zip Channel 100 Slim Shade
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Angle Roller Shade System
Interior Fixed Panel System
Exterior Wire Guide Roller Shade System
Exterior Straight Drop Roller Shade
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Somfy Low Voltage
Automate Rollease Battery
Automate Rollease Line Voltage
Automate Rollease Low Voltage
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Soft Roman Shade System
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Dealers Application Form
Buyer Identification
"Buyer" includes all subsidiaries, division and affiliates
Primary Specialization
First Name
Last Name
Trade name (if different)
Business Address
Federal EIN
State Resale Cert. #
Business Type
Contact Names
Office Phone
Cell Phone
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Dates Business Formed
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Email
History
State Business Formed
Have you done business under any other name in the past 5 years?
*
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With us?
*
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No
Have you or any company with which you were associated in the past 5 years been subject to any bankruptcy or insolvency proceeding?
*
Yes
No
Are there any judgments or legal proceedings pending or threatened respecting Buyer or any Guarantor?
*
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No
Company Principals-Owners
(All must be set forth below)
1.
Name
Title
2.
Name
Title
3.
Name
Title
Drivers Lic. No
Home Address
Home Phone
Drivers Lic. No
Home Address
Home Phone
Drivers Lic. No
Home Address
Home Phone
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