ADVANCED SLEEVE
9348 Mercantile Dr. Mentor, Ohio 44060
Ph: 440-354-3440  Fax: 440-354-3408
DEALER APPLICATION FORM

PRINT, COMPLETE AND MAIL OR FAX THIS FORM TO ADVANCED SLEEVE


Company Name: _____________________________________________________________________

Address: __________________________________________________________________________

City: _____________________________________ State: _____________ Zip: _____________

Phone: (      )___________________________ Fax: (      )___________________________

Owner's Name: _____________________________________________________________________

Bank Name: ________________________________________________________________________

Sales Tax #: ___________________________ Federal Tax #: ___________________________

Accounts Payable Person: __________________________________________________________

Sales Email Address: ______________________________________________________________


BUSINESS REFERENCES


Company Name: _____________________________________________________________________

Address: __________________________________________________________________________

City: _____________________________________ State: _____________ Zip: _____________

Terms: ____________________________________________________________________________


Company Name: _____________________________________________________________________

Address: __________________________________________________________________________

City: _____________________________________ State: _____________ Zip: _____________

Terms: ____________________________________________________________________________