Reseller application
Account Application Instructions:
1, Please complete as much info as
you can below
2, Pleas fax this page with a copy
of your Business License/Resale Permit and owner's Driver's License.
Account FAX Application Requirement
_______________________________________________________________________
1305 Lakes ParkWay Suite #
107
Lawrenceville GA 30043 * Ph: 678-407-4983 *
678-407-2062 *
Fax: 678-407-0262
www.iPremiertek.com
sales@ipremiertek.com
| Legal Business
Name |
- |
| President/Owner |
- |
| Doing Business
As |
- |
| Shipping/Billing
Address |
- |
| Business Phone
Number |
- |
| Business Fax
Number |
- |
| E-mail Address |
- |
| Business Website
Address |
- |
| Authorized
Purchaser |
- |
| Date Business
was founded |
- |
| Length of time
at this address |
- |
| Items You are
interested |
- |
| Quantities per
item |
- |
| Items You are
interested |
- |
| Quantities per
item |
- |
|
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