ELECTROSALES Dealer Application

This is not an application for credit terms with Electrosales.
We request a credit card for all purchases. No COD's please.
$250 minimum opening order. Subsequent orders are minimum $50.

Please fill out this Sales/Use Tax Exemption Certificate (PDF) and fax it in to us - 417-869-6568 / Attn: Daniel Chilton

Business Information
Business Name......
Contact Name........
Title.......................
Street Address.......
Address (cont.).......
City.........................
State.......................
Zip Code.................
Country..................	U.S. Only
Phone....................
FAX........................
E-Mail.....................

Shipping Address (if different)
Street Address.......
Address (cont.)......
City........................
State......................
Zip Code................
Country (US Only)

State Sales Tax #...
*Resale Certificate Required

Please list the name and address of the person(s)
that should be given access to our online price lists.

Name......................
Email......................
Name......................
Email.......................

Choose one of the following options:

Sole Proprietorship
Partnership
Joint Venture
Corporation
Limited Partnership

Choose one of the following options:

Sound Contractor
Music Store
Audio and Video Installer/Supplier
Manufacture
Other

How long in business?

years months

How long at present address?

years months

Please list the lines you are a factory authorized (direct) dealer for: