K E N W O O D C O M M U N I C A T I O N S
© Copyright 2006 e Commerc e Supply Page 5
DEALER APPLIC ATION

(Easy On-Line Application Available at w ww.ecom-supply.com)

Company Name ____________________________________________________________________ Date ______________________________
Address/City/State/Zip ___________________________________________________________________________________________________
Telephone _________________________ FAX _______________________ Web Address ___________________________________________
Type of Business and Products Sold _______________________________________________________________________________________
[ ] Corporation (State _________) [ ] S ole Proprietorship [ ] Partnership Years in Business ___________
General Manager ____________________________________________________ Email Address _____________________________
Sales Manager _______________________________________________________ Email Address _____________________________
Accts Payable Contact _________________________________________________ Email Address _____________________________
Tax Resale Number ___________________________________ Please provide a copy of your State Tax Resale Certifi cate with Ap pli ca tion
Payment Type [ ] Major Bankcard [ ] COD *[ ] Net 30 Days (On Approved Credit with Opening Radio Order)
* 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).
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BANK REFERENCE
Bank ___________________________________________________ Telephone _________________________ FAX _______________________
Address/City/State/Zip __________________________________________________________________________________________________
Contact ______________________________________________________ Account Number _________________________________________
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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 _____________________________ Date ____________________
KENWOOD MASTER P ROTALK 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