Reseller Application Form

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CENTRAL PARTS WAREHOUSE RESELLER APPLICATION
If you are not a reseller, please fill out and fax to (815)469-6958
*******Must Fax a Copy of Your State/Reseller Certificate with This Form*******
Company Name: ____________________________________________________________________________
Contact Person(s):___________________________________________________________________________
Company Address: __________________________________________________________________________
Fed Tax ID# or Social Security #:_______________________________________________________________
Email Address: _____________________________________________________________________________
Phone Number: _____________________________ Fax Number: ___________________________________
Type of Business: __________________________________________________________________________
Currently Selling Snow & Ice Removal Equipment/Parts
Yes
No
If so, which brands? ________________________________________________________________________
Currently Selling Truck Equipment/Accessories
Yes
No
If so, which brands? ________________________________________________________________________
Surrounding Area Competition: ______________________________________________________________
Anticipated Annual Volume: ($2500 Minimum per Year) ______________________________________________
Size of Facility/Business: (in sq. footage) _________________________________________________________
Type of Market Business is involved in:
Repair Shop
Parts Store
Store Front/ Garage
Drop Shipper
Brands of Equipment that you would like to sell:
Boss
Buyers
Fisher
Meyer
Western
Snowman
Ecco
Curt
Bedrug
Husky
Putco
Timbren
Bestop
Bakflip
Other Brands______________________________________________________________________________
Signature: ________________________________________________________________________________
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