BECOME A DEALER FORM
FILL UP THE APPLICATION BELOW TO BECOME A DEALER TO BE ABLE TO ORDER PHONES.
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COMPANY NAME
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DBA (if any)
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FEDERAL TAX ID
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TYPE OF BUSINESS
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( PARTNERSHIP , SOLE PRORIETORSHIP, CORPORATION, LLC )
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FULL NAME
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STREET ADDRESS
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CITY
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STATE
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ZIP CODE
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WORK NUMBER
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MOBILE NUMBER
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EMAIL ADDRESS
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TRADE REFERENCES
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COMPANY NAME
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TRADE REFERENCES
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CONTACT PHONE #
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TRADE REFERENCES
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CONTACT NAME #
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TRADE REFERENCES
COMPANY ADDRESS
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TRADE REFERENCES # 2
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COMPANY NAME
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TRADE REFERENCES # 2
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CONTACT PHONE #
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TRADE REFERENCES # 2
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CONTACT NAME #
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TRADE REFERENCES # 2
COMPANY ADDRESS
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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.
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"YES" OR "NO"
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