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Reseller Account Application
829 Lawson St.
City of Industry, CA 91748 |
Ph: 626-964-2176
Fax: 626-964-2376
www.Premiertek.net resellers@premiertek.net |
Account Application Instructions:
1, Please complete as much info as you can below
2, Pleas fax this page with a cope of your Business
License/Resale 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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