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Reseller Account Application
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Premiertek.net, LLC
1500 S Milliken Ave, Unit J
Ontario, CA 91761 |
Ph: 909-560-9690
Fax 909-465-5451
www.Premiertek.com saels@premiertek.com |
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/Reseller Permit and owner's Driver's License.
| Legal Business Name |
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| President/Owner |
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| Doing Business As |
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| Shipping/Billing Address |
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| Business Phone # |
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| Business Fax # |
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| E-mail Address |
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| Business Website Address |
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| Authorized Purchaser |
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| Date Business was founded |
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| Length of time at this address |
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| Items You are interested |
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| Quantities per item |
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