BECOME A DEALER FORM
FILL UP THE APPLICATION BELOW TO BECOME A DEALER TO BE ABLE TO ORDER PHONES.
COMPANY NAME *
DBA (if any)
FEDERAL TAX ID *
TYPE OF BUSINESS *
( PARTNERSHIP , SOLE PRORIETORSHIP, CORPORATION, LLC )
FULL NAME *
STREET ADDRESS *
CITY *
STATE *
ZIP CODE *
WORK NUMBER *
MOBILE NUMBER *
EMAIL ADDRESS *
TRADE REFERENCES *
COMPANY NAME
TRADE REFERENCES *
CONTACT PHONE #
TRADE REFERENCES *
CONTACT NAME #
TRADE REFERENCES
COMPANY ADDRESS
TRADE REFERENCES # 2 *
COMPANY NAME
TRADE REFERENCES # 2 *
CONTACT PHONE #
TRADE REFERENCES # 2 *
CONTACT NAME #
TRADE REFERENCES # 2
COMPANY ADDRESS
I hereby certify that the information presented on this application is correct to the best of my knowledge. My signature below constitutes an authorization for Cell 2 Talk, Inc. to contact the above references so that Cell 2 Talk, Inc. can establish an account on my behalf. *
"YES" OR "NO"
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