NEW DEALER Application Form
 
Action Mfg & Mktg Co.
Box 1586
Oak Lawn, IL 60455

Thank you for your interest in becoming a member of our resale "Glo-Marker" network.  Upon receipt of the information you provide in our below  "Wholesale Dealer Application Form" you will be contacted after all information is verified.  Should it be determined all is accurate and you qualify as a Glo-Marker reseller, a business account will then be set up for you as listed below.  Please be complete, and accurate.

Privacy Guarantee: We do not sell, share, or transfer any information provided from the application process to outside  companies, now or  after the application process.

Desired Login Name:     (6 to 20 Char), This is your doorway into your account once set up on your behalf.
Desired Password:   (6 to 10 Char), You will be contacted via email when your account is approved.
     
 
   
Bill To:              Business Contact Info
First Name
Last Name
Position / Title
Business Name  Store #
Address Line 1
Address Line 2
City
State/Province Zip  
Email
Website   < Enter if have
Phone  <format ext.
Fax
   
Ship To:              same as billing address
First Name
Last Name
Position / Title
Business Name   Store #
Address Line 1
Address Line 2
City
State/Province Zip
Email
Website   < Enter if have
Phone   ext.
Fax
Please fill in all valid contact fields that apply.

It is not uncommon to receive an order from a Management or Purchasing Contact
wanting the order paper work receipt to arrive at their Bill To: location and the product at the Ship To: location. This can involve three people for tracking of order particulars.

To better assist you with possible order variables, please provide the valid contact information pertaining to your ordering habits..
Management Contact
 

 
Phone:  ext.
Fax:  
 
Purchasing Agent Contact

Phone: ext.
Fax:  
Accounting Payables Contact

Phone: ext.
Fax:  

How did you discover our product  

What type of business are you:    if "other" specify >

What type of products to you sell:  

How are your products sold:  

Describe your sales area / territory:

"required"      Business organized as (check one) fill in blank

Sole Proprietorship >

 < Owners Name

Partnership >

 < Name Partners

Corporation >

 < President

Date Business Established < 4 digit year 

CERTIFICATE OF RESALE FORM

The undersigned hereby certifies that all products and goods hereafter purchased by the above business entity form the vendor is for purposes of resale, and assumes liability for payment of Sales Tax, Use Tax, Retailers Occupation Tax, or Service Occupation Tax, with respect to receipts from the resale of property purchased from vendor for resale to its users or consumers.

This certificate shall be considered a part of each order which the above business entity shall place, unless such order is specified otherwise.

Resale Tax #

Name of Resellers agent authorizing this certificate:

 
List two MAIN product suppliers you do business within your trade.
(NOTE: this is not a credit application)
 Vendor 1:
  Contact:
Email:
Title:
  Company:
Telephone: Format> 555 123-1234  
Fax: Format> 555 123-1234
Address:
 
  City:
   
Zip Code:
Web Site: 
What Purchased
Aver Monthly Purchase $
Vendor 2:    
Contact:
Email:
Title:
Company:
Telephone: Format> 555 123-1234 
Fax: Format> 555 123-1234
Address:
 
  City:
Zip Code:
Web Site:
What Purchased
Aver Monthly Purchase $

Special Message or Additional Comments to add >

Name of Person Completing this form: