Restorers Wholesale Application
Transcription
Restorers Wholesale Application
Restorers Restorers Acquisition AcquisitionInc. Inc.DBA DBAVan VanDykes DykesRestorers Restorers 1011801 West POVan Coats BoxDyke 52, St.,Louisiana, Floor Moberly MO 63353 MO57301 65270 Drive,3,Mitchell, SD 800-495-9689 www.vandykes.com Tel:Tel: 605-996-2840 x108 www.vandykes.com Wholesale Buying Application: Wholesale Buying Application: Please complete form apply wholesalestatus. status. Please complete thisthis form to to apply forfor wholesale All information supplied will be held in strict confidence. All information supplied will be held in strict confidence. Source:Source: COMPANY NAME: ____________________________________________________________________ COMPANY NAME: ____________________________________________________________________ ADDRESS: ____________________________________________________________________________ ADDRESS: ____________________________________________________________________________ CITY/STATE/ZIP: ______________________________________________________________________ CITY/STATE/ZIP: ______________________________________________________________________ CONTACT PERSON: ___________________________________________________________________ CONTACT PERSON: ___________________________________________________________________ BUSINESS TELEPHONE: ___________________________ BUSINESS FAX: _____________________ BUSINESS TELEPHONE: ___________________________ BUSINESS FAX: _____________________ Please me emails E-MAIL ADDRESS: __________________________________________ Please E-MAIL ADDRESS: __________________________________________ sendsend me emails aboutabout special special offers from Restorers Wholesale. offers from Restorers Wholesale. Please provide shipping address if differentfrom fromthe theabove above address. Please provide shipping address if different address. ADDRESS: ____________________________________________________________________________ ADDRESS: ____________________________________________________________________________ CITY/STATE/ZIP: ______________________________________________________________________ CITY/STATE/ZIP: ______________________________________________________________________ BUSINESS DOCUMENTATION **Required: PHOTOCOPY** BUSINESS DOCUMENTATION **Required: PHOTOCOPY** Please attach a photocopy of one the following items to demonstrate the establishment of a business. All documentation must be inathe name of the business with the address above. the establishment of a business. All documentation Please attach photocopy of one the following items toshown demonstrate Tax of Certificate ____Federal Id must_____Resale be in the name the business with the address shownTax above. _____Resale Tax Certificate ____Federal Tax Id _____Business License _____Business License CUSTOMER PROFILE INFORMATION To best serve PROFILE the needs of our customer, it is helpful for us to determine as much about our customer’s busi ness as possible. CUSTOMER INFORMATION We serve wouldthe appreciate completion appropriate section of this To best needs ofyour ourcooperation customer, itinisthe helpful for us of to the determine as much about ourform. customer’s business as possible. We would appreciate your cooperation in the completion of the appropriate section of this form. WHICH OF THE FOLLOWING BEST DESCRIBES YOUR COMPANY WHICH FOLLOWING BEST DESCRIBES YOUR COMPANY (Place aOF 1 forTHE primary and a 2 for secondary) (Place a 1 for primary and a 2 for secondary) Design/Architecture Design/Architecture ___ Architectural Firm ___ ___ Architectural Firm Firm Interior Design ___ ___ Interior Design Firm Kitchen/Bath Design Firm ___ Kitchen/Bath Design Firm ___ General Contractor ___ Model Home Construction OEM Manufacturer Building/Construction Building/Construction ___ Home Improvement Contracting Firm ___ Home Improvement Contracting Firm Firm ___ Kitchen/Bath Remodeling ___ Kitchen/Bath___ Remodeling Firm Firm Custom Building ___ General ___ Custom Building Firm Contractor ___ Model Home Construction Retail/Wholesale OEM Manufacturer Retail/Wholesale ___Custom Cabinet Manufacturer ___ Antique Restoration/Refinisher ___Custom Furniture Manufacturer ___ Home Center ___Custom Cabinet Manufacturer ___ Antique Restoration/Refinisher ___Hotel Furniture ___ ___Custom Furniture Manufacturer ___ Home Center Decorative Hardware Retailer ___ Hospital Furniture ___ Plumbing Retailer ___Hotel Furniture ___ Decorative Hardware Retailer ___ Retail Display Furniture ___ Lumber Yard/Building Supply ___ Hospital Furniture ___ Plumbing Retailer ___ Retail Display Furniture ___ Lumber Yard/Building Supply revised 8/1/11 ___ Other: _____________________________ ___ Other: _____________________________ revised 8/1/11 Please this completed form, alongwith with aacopy of one document.document. Please return thisreturn completed form, along copy of business** one business** Mail to: 1801 Van Dyke Drive, Mitchell, SD 57301 Mail to: PO 101 Box West52, Coats Louisiana, St., Floor MO 3,63353 Moberly MO 65270 Fax: 605-996-2069 Email: [email protected] Fax: 800-477-8271 Email: [email protected]