| If you would like to be an authorized wholesaler, please fill this application form and fax/email/mail it to us: |
| Company: ALaCarteNet Ltd. |
| Address: 18. Villanyi street |
| Budapest, Hungary, H-1113 |
| Phone: +36-30-921-4561 |
| Fax: +1-360-287-0481 |
| Email: info@crystalacarte.com |
|
| Click here to download the application form (MS-Word) » |
| Or print this page, complete and fax it to us, thank you. |
|
| |
| APPLICANT INFORMATION |
| Business Name ____________________________ |
| |
| CONTACT INFORMATION |
| Physical Address |
| Street ___________________________ City ______________________________ |
| State/Prov _______________ Zip/Postal ______________ Country _____ |
| Contact ___________________Telephone ( ) Fax ( ) |
| E-mail _____________________________ |
| Web Address ________________________________ |
| Shipping Address (Only if different from Physical Address) |
| Street ___________________________ City ______________________________ |
| State/Prov _______________ Zip/Postal ______________ Country _____ |
| Billing Address (Only if different from Physical Address) |
| Street ___________________________ City ______________________________ |
| State/Prov _______________ Zip/Postal ______________ Country _____ |
| |
| BUSINESS QUESTIONS |
| Type of business (please underline) |
| Sole proprietorship Partnership |
| Limited partnership LLC |
| Corporation |
| |
| Owners _______________________________________ |
| Managers ______________________________________ |
| Corporate Officers & Titles: |
| ______________________ _______________________ |
| ______________________ _______________________ |
| ______________________ _______________________ |
| |
| Year Established _____________________ Resale Tax# _______________________ |
| Has this facility previously been an Ajka Crystal Dealer? Yes/No |
| If yes under what name?___________________________ |
| |
| STAFF QUESTIONS |
| Please list the name and agencies of instructors who are affiliated with Your facility |
| ______________________ ________________ |
| ______________________ ________________ |
| ______________________ ________________ |
| List of persons who are approved to place orders for products: |
| ______________________ ________________ |
| ______________________ ________________ |
| ______________________ ________________ |
| |
| Preferred method of payment: |
| COD |
| Approved Account (We send you a credit application form) |
| |
| |
| THANK YOU |
| AlaCarteNet Ltd. |
| |
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