Premier Performance - Dealer Application

:: Business Information ::

Business Name:

Billing Address:

Shipping Address:

Same as Billing

Business Phone: Fax:

Website Address:

:: Additional Information ::

Federal Tax ID#: Seller's Permit:

Does State, County, or City require a license?
No Yes

How do you want to recieve your invoices?

Email Use Principle Owner Email New Email
Fax Use Business Fax New Fax
Mail (At Billing Address)

What email address do you want to receive tracking #'s?
Use Principle Owner Email Use Invoice Email New Email

Order Contact:

Payables Contact:

Ownership Type: Sole ProprietorPartnershipCorporation

Principle:

No. Of Employees: Est. Annual Sales Sales Area:

Trade References

Reference 1: Phone Fax

Reference 2: Phone Fax

:: Credit Terms ::

Which Method of Payment Would You Like? Credit CardC.O.D.

*Once your application is recieved, someone will contact you for your credit card information.

= Required

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