Dealer Application Form
Please complete all sections to apply as an authorized MOC7 dealer. All information will be kept confidential.
Business Information
Name of Business
*
Street Address
*
Mailing Address
*
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Cell
Please enter a valid phone number.
Format: (000) 000-0000.
Fax
Please enter a valid phone number.
Format: (000) 000-0000.
E-Mail
*
example@example.com
Website Address
Primary Contact Person
*
Form of Business
*
Sole Proprietorship
Partnership
Corporation
LLC
Other
Nature of Business
*
Markets you generally do business in
Sales Tax No.
State
Employer ID No.
Year Business Established
DUNS#
Names of Owners, Partners, Shareholders, Officers:
Business Bank References
Trade References
*
Additional Information: Please provide any additional information that you feel would be helpful to us in evaluating your application. If this is a new business, please give us a brief description of your business plan, any other products you plan to carry or services you plan to provide, where you plan to market, any other dealerships in progress, as well as information concerning your past experience in business and employment. Attach additional sheets as necessary.
The applicant attests that the information and statements provided in this application including attachments are true and complete, and are made for the purpose of inducing Ag Odor Control, LLC to grant a dealership and allow applicant to submit company checks for prepayments and on account. In support of this application, Ag OdorControl, LLC, is hereby authorized to investigate applicant's credit record and references and obtain business and/or personal credit and/or financial information o n the applicant and its principals. Applicant agrees to provide further financial information and documentation, including financial statements, as may be required from time to time. The undersigned jointly and severally if more than one, hereby unconditionally and absolutely guarantee to Ag OdorControl, LLC, the prompt and full payment and performance when due of all indebtedness and obligations which they may now or at any time hereafter owe Ag Odor Control, LLC, including without limitation, interest and collection costs.
*
Agree
Signatures & Authorization
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Signature of Principal 1
*
Printed Name of Principal 1
*
Title of Principal 1
*
Signature of Principal 2
Printed Name of Principal 2
Title of Principal 2
Signature of Principal 3
Printed Name of Principal 3
Title of Principal 3
Submit Application
Submit Application
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