NOTE: To email
the form to us, highlight all the information below and save it to your
own computer. Then fill it out on your
word processor and email it to us as an attachment.
|
DISTRIBUTOR
APPLICATION Date Received ______________ Date Approved ______________ Distr. No. __________________ Company Name: ________________________________________________________________ Address: ________________________________________________________ City/State/Zip: ____________________________________________________ Telephone: ___________________ Alternate Phone: ____________________ Fax: _________________ Email Address: ____________________________ Contact Person: __________________________________ Title: ___________________________________________ Date Business Established: __________________________________________ Tax ID No. ______________________ No. of Employees _________________ Sales Volume Projected in Units of Cross of America™ Products Pins _________ __________ T’s _________ __________ Decals _________ __________ Ownership: Partnership _____ Corporation _____ Sole Proprietor _____ Brief Description of your products and services: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ I will advise Cross of
America, Inc. if any information supplied should change. Company Name: __________________________________________________ Applicant Signature: ________________________________________________ Applicant Name Printed: _____________________________________________ Applicant Title: ____________________________________________________ Date: ____________________________
Send this form by fax, email or mail: Cross of America™
|
CLOSE WINDOW TO RETURN TO DISTRIBUTOR INFORMATION PAGE