Inline Tube Dealer Application

Dealer Account Application

15066 Technology Dr. Shelby Twp, MI 48315

Business Contact Information
Company Name:*
Registered Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Phone*
Please enter a valid phone number.
Company Fax
Please enter a valid fax number.
Company Email
example@example.com
Date Business Commenced*

MonthDayYear
Type of Business*
Preferred Payment Method*

Credit CardNet30

Business & Credit Information
Purchaser*

First NameLast Name
Purchaser Phone Number*
Please enter a valid phone number.
Purchaser Fax Number
Please enter a valid fax number.
Purchaser Email*
example@example.com
Billing Contact*

First NameLast Name
Billing Phone Number*
Please enter a valid phone number.
Billing Fax Number
Please enter a valid fax number.
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.
Type of Account*

Business & Trade References
Reference 1
Company*
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*
Please enter a valid phone number.
Fax Number
Please enter a valid fax number.
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.
Fax Number
Please enter a valid fax number.
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.
Fax Number
Please enter a valid fax number.
Email*
example@example.com
Type of Account*

Agreement
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*

Clear
Date Signed

MonthDayYear
Please Fill out and save this Tax Exempt Certificate for upload in the next step:
Tax Exempt Certificate File Upload*

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