Company Name:
Home Office Address: City: , State: Zip/Postal Code:
Phone: Fax: Toll Free:
E-mail: Website:
Billing Address: City: State: Zip/Postal Code:
Tax Exempt #:
Year Company established: State of Incorporation:
How many branch locations does the company have 0 1 2 3 4 5 6 7 8 9 10 10-15 15-20 20-25 25-30 30+ . Do you allow branch billing Yes or No Yes No
Branch billing /shipping address:
Branch Manager:
How many outside sales people do you employ Inside sales personnel
Who is authorized to issue orders for your company
Company Principals:
President
Sales Manager
Advertising Manager
Operations Manager
Accounts Payable Manager
Prior years gross sales (approximate):
Territories actively covered by outside sales staff:
Credit References (Three required):
Address: City: State: Zip/Postal Code:
Telephone: Fax:
Bank Reference
Bank:
Account #
Contact:
List key manufacturers sold by your company under each product line category below:
Respiratory Equipment:
Compressors:
Ventilation Equipment:
Air Filtration:
Instrumentation:
Fire Service:
HEPA Vacuums:
Sales Personnel History:
Name:
Territory Covered:
Air Systems International is committed to our customers needs and special requirements. Success in marketing of our products is achieved through product demonstrations to the customer. To achieve this, sales samples are needed to support the effort and are offered at special demo discounts. Catalogs and price lists are available no charge. Contact our Customer Service Department for handling demo orders and obtaining catalogs and price lists.
Title:
Date:
Product Loyalty Bonus: Accept or Decline Accepted Declined
Note: The above Product Loyalty Bonus must be signed and accepted by all distributors submitting applications before additional discounts are received.
