PROFESSOR
MOTOR INC
Ph
: 734-462-4226 Fax : 734-462-4211
38291 Schoolcraft Road - Suite 104, Livonia MI 48150
Thank you for your interest in retailing Professor Motor products.
Please
print, complete and mail (via post office) this application to the address
above.
Today’s
Date : ______________ Business
Name : ____________________________________
Date Business
Established : ________________ Business Phone: (_____) _________________
Business
D.B.A. __________________________ Business
Fax : (_____) __________________
Business
Street Address : ____________________________
Email : _____________________
City
: __________________ State /
Province : ______________ Zip
/ Postal Code : _________
Shipping
Address (if different) : ____________________________
City : ___________________
State
/ Province : _______________ Zip
/ Postal Code : ___________
Business
License No. (Tax ID) : __________________
Web Site : ________________________
Business
Location (Circle One) : Mall Warehouse
Commercial Store Front Other
(______)
Primary
Revenue Source (Circle One) : Internet
Retail Resale to
Dealers Mail Order
Retail
Store Front
Retail Sales Other
(_________________)
Type
of Business (Circle One) : Corporation
Partnership Proprietorship Other (__________)
Name & Address of Principals
1.
Name : ________________________________ Title
: ________________________________
Home Address
: _________________________ City :
________________________________
State /
Province : __________ Zip / Postal
Code : _________ Phone : (_____)
____________
2.
Name : ________________________________ Title
: ________________________________
Home Address
: _________________________ City :
________________________________
State /
Province : __________ Zip / Postal
Code : _________ Phone : (_____)
____________
3.
Name : ________________________________ Title
: ________________________________
Home Address
: _________________________ City :
________________________________
State /
Province : __________ Zip / Postal
Code : _________ Phone : (_____)
____________
4.
Name : ________________________________ Title
: ________________________________
Home Address
: _________________________ City :
________________________________
State /
Province : __________ Zip / Postal
Code : _________ Phone : (_____)
____________
Please
list business references from your major suppliers below & provide pictures
of your store :
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______________________________________________________________________________
______________________________________________________________________________
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