United Fabrics



Dealer Application
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Company Information
* Company Name:
Company Address  
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* Business Email: * Contact Name:
* Business Entity: Single Proprietor
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* Taxable: Yes
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* Average Monthly Purchases: Years In Business:
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* Choose the payment terms that best fit your business: Credit Card
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Trade References: List three from whom you have purchased using the above terms.
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Reference Contact Name: Reference Email:
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Reference Contact Fax:
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Reference Name:
Reference Address  
Street:  
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Zip:
Country:
Reference Contact Name: Reference Email:
Reference Contact Business Phone: Reference Contact Home Phone:
Reference Contact Fax:
Reference Remarks:
Reference Name:
Address  
Street:  
City:
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Zip:
Country:
Reference Contact Name: Reference Email:
Reference Contact Business Phone: Reference Contact Home Phone:
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