Inline Tube Dealer Application

Dealer Account Application

15066 Technology Dr. Shelby Twp, MI 48315
- Company Name:
- Registered Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Company Phone
  Please enter a valid phone number.Format: (000) 000-0000.
- Company Fax
  Please enter a valid fax number.Format: (000) 000-0000.
- Company Email
  example@example.com
- Date Business Commenced
  
  MonthDayYear
- Type of Business
- Preferred Payment Method
- Purchaser
  
  First NameLast Name
- Purchaser Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Purchaser Fax Number
  Please enter a valid fax number.Format: (000) 000-0000.
- Purchaser Email
  example@example.com
- Billing Contact
  
  First NameLast Name
- Billing Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Billing Fax Number
  Please enter a valid fax number.Format: (000) 000-0000.
- Billing Email
  example@example.com
- Bank Name
- Bank Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Bank Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Type of Account
- Reference 1
- Company
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Fax Number
  Please enter a valid fax number.Format: (000) 000-0000.
- Email
  example@example.com
- Type of Account
- Reference 2
- Company
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Fax Number
  Please enter a valid fax number.Format: (000) 000-0000.
- Email
  example@example.com
- Type of Account
- Reference 3
- Company
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState
  
  Zip Code
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Fax Number
  Please enter a valid fax number.Format: (000) 000-0000.
- Email
  example@example.com
- Type of Account
- 1. All invoices are to be paid 30 days from the date of the invoice.
  2. Claims arising from invoices must be made within seven working days.
  3. By submitting this application, you authorize Inline Tube, Inc. to make inquiries into the banking and business/trade references that you have supplied.
- Applicant Name
  
  First NameLast Name
- Signature
- Date Signed
  
  MonthDayYear
- Please Fill out and save this Tax Exempt Certificate for upload in the next step:
- Tax Exempt Certificate File Upload
  
  Cancelof
- Should be Empty:

Dealer Account Application