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K E N W O O D
C O M M U N I C A T I O N S
DEALER APPLICATION
(Easy On-Line Application Available at www.ecom-supply.com)
Company Name ____________________________________________________________________ Date ______________________________
Address/City/State/Zip ___________________________________________________________________________________________________
Telephone _________________________ FAX _______________________ Web Address ___________________________________________
Type of Business and Products Sold _______________________________________________________________________________________
[ ] Corporation (State _________)
General Manager ____________________________________________________
Sales Manager _______________________________________________________
Accts Payable Contact _________________________________________________
Tax Resale Number ___________________________________ Please provide a copy of your State Tax Resale Certifi cate with Ap pli ca tion
Payment Type
[ ] Major Bankcard
* Please allow 5 to 10 working days to process an open account application. If product is needed immediately, orders can be shipped via UPS COD or paid with a bankcard (3% fee may apply).
==========================================================================
BANK REFERENCE
Bank ___________________________________________________ Telephone _________________________ FAX _______________________
Address/City/State/Zip __________________________________________________________________________________________________
Contact ______________________________________________________ Account Number _________________________________________
==========================================================================
SUPPLIER REFERENCES
Supplier ________________________________________________ Telephone _________________________ FAX _______________________
Address/City/State/Zip ___________________________________________________________________________________________________
Contact ______________________________________________________ Account Number _________________________________________
Supplier ________________________________________________ Telephone _________________________ FAX _______________________
Address/City/State/Zip ___________________________________________________________________________________________________
Contact ______________________________________________________ Account Number _________________________________________
Supplier ________________________________________________ Telephone _________________________ FAX _______________________
Address/City/State/Zip ___________________________________________________________________________________________________
Contact ______________________________________________________ Account Number _________________________________________
Authorized By ____________________________________________ Title _____________________________
© Copyright 2006 e Commerce Supply
[ ] S ole Proprietorship
[ ] COD
KENWOOD MASTER PROTALK DISTRIBUTOR
e Commerce Supply
15375 Barranca Pkwy H108
Irvine, CA 92618-2209
949-502-5588 949-480-0039 FAX
www.ecom-supply.com
radios@ecom-supply.com
[ ] Partnership
Email Address _____________________________
Email Address _____________________________
Email Address _____________________________
*[ ] Net 30 Days (On Approved Credit with Opening Radio Order)
Years in Business ___________
Date ____________________
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