Aplicacion Paintball

Dealer Application Form
Please note that you WILL need the following in order to complete this form:
• • • Copies of invoices from Suppliers to confirm trade references.Copy of Business License. Picture of Store Front. Sent:   Sent:   Sent:  

Company Name Billing Address:

Years in Buisness

……………………………………………………………………………………………………………………. …………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………….   Zip Code: Years at Address:

Shipping Address:

……………………………………………………………………………………………………………………. …………………………………………………………………………………………………………………….…………………………………………………………………………………………………………………….   Zip Code: Years at Address:

Owners Name: Buyers Name: Tel Number: Fax Number: E‐Mail: Web Site Address: Business License Information…… Federal Tax ID No.:  Name: SSN No.:Type of Company
{i.e Private Corp, Partnership, LLC Etc}

State:
Issue Date:

Copy sent:

YES    /    NO

Where did you hear about Planet Eclipse?

Bank Details Bank Name: Account Number:Bank Contact: Bank Address: Phone Number: Routing No.:

Trade References. Company: Address: Account No.:

Sales Rep: Phone No.: Fax No.: 

Company: Address:

Account No.:

Sales Rep: Phone No.:Fax No.: 

Company: Address:

Account No.:

Sales Rep: Phone No.: Fax No.: 

• • • •

Have you Enclosed the following???? Copies of invoices from Suppliers to confirm trade references. Copy of Business License.  Picture of Store Front.  All 3 Pages of this Application Form. 

Dealer Application ‐ Closing Statement  By signing below I hereby declare that the above information is true to best of my knowledge. I am aware that falsification of any of this information may result in denial of application by Planet Eclipse LLC.   By  signing  this  document  I  have  indicated permission  for  Planet  Eclipse  LLC  to  obtain  credit information from the sources I have referenced, including external credit reporting sources and any...