Billet-1 Quality NASCAR furnishings for the home and beyond

DEALER APPLICATION

We are glad you are interested in ordering. Billet-1 products are available from quality distributors from around the world. We welcome this opportunity to partner with your business.

Contact Name:
Company Name:
SHIPPING Address:
SHIPPING Address2:
	City ST Zip
BILLING Address: (If different)
BILLING Address2:
	City ST Zip
Phone No.:
Fax No.:
E-mail:
Position:
Website
Type of Business:
List the business owners and corporate officers, along with titles	List business owners and officers along with their titles
Date business esablished:
Business License Number :
DUNS Number :
Resale Tax #
Business Reference 1:
Business Ref 1 Fax #:
Business Reference 2:
Business Ref 2 Fax #:
Business Reference 3:
Business Ref 3 Fax #:
Preferred method of payment:
Please provide a brief description of your company, including the specific markets you serve and the products you sell: Please provide a brief description of your company. Please provide a list of the people who would be approved to place orders on this account. People approved to place orders on account

Thank you for completing this form! For more information, contact us at
info@billet-1.com or call 785-771-2100.