Restorers Wholesale Application

Restorers
Restorers Acquisition
AcquisitionInc.
Inc.DBA
DBAVan
VanDykes
DykesRestorers
Restorers
1011801
West
POVan
Coats
BoxDyke
52,
St.,Louisiana,
Floor
Moberly
MO 63353
MO57301
65270
Drive,3,Mitchell,
SD
800-495-9689
www.vandykes.com
Tel:Tel:
605-996-2840
x108
www.vandykes.com
Wholesale
Buying
Application:
Wholesale
Buying
Application:
Please
complete
form
apply
wholesalestatus.
status.
Please
complete
thisthis
form
to to
apply
forfor
wholesale
All
information
supplied
will
be
held
in
strict
confidence.
All information supplied will be held in strict confidence.
Source:Source:
COMPANY NAME: ____________________________________________________________________
COMPANY NAME: ____________________________________________________________________
ADDRESS: ____________________________________________________________________________
ADDRESS: ____________________________________________________________________________
CITY/STATE/ZIP: ______________________________________________________________________
CITY/STATE/ZIP: ______________________________________________________________________
CONTACT PERSON: ___________________________________________________________________
CONTACT PERSON: ___________________________________________________________________
BUSINESS TELEPHONE: ___________________________ BUSINESS FAX: _____________________
BUSINESS TELEPHONE: ___________________________ BUSINESS FAX: _____________________
Please
me emails
E-MAIL
ADDRESS:
__________________________________________  Please
E-MAIL
ADDRESS:
__________________________________________
sendsend
me emails
aboutabout
special
special offers
from
Restorers
Wholesale.
offers from Restorers Wholesale.
Please
provide
shipping
address
if differentfrom
fromthe
theabove
above address.
Please
provide
shipping
address
if different
address.
ADDRESS: ____________________________________________________________________________
ADDRESS: ____________________________________________________________________________
CITY/STATE/ZIP: ______________________________________________________________________
CITY/STATE/ZIP: ______________________________________________________________________
BUSINESS DOCUMENTATION **Required: PHOTOCOPY**
BUSINESS DOCUMENTATION **Required: PHOTOCOPY**
Please attach a photocopy of one the following items to demonstrate the establishment of a business. All documentation
must
be inathe
name of the
business
with the address
above. the establishment of a business. All documentation
Please
attach
photocopy
of one
the following
items toshown
demonstrate
Tax of
Certificate
____Federal
Id
must_____Resale
be in the name
the business with the address
shownTax
above.
_____Resale
Tax
Certificate
____Federal
Tax
Id
_____Business License
_____Business License
CUSTOMER PROFILE INFORMATION
To best serve PROFILE
the needs of our
customer, it is helpful for us to determine as much about our customer’s busi
ness as possible.
CUSTOMER
INFORMATION
We serve
wouldthe
appreciate
completion
appropriate
section
of this
To best
needs ofyour
ourcooperation
customer, itinisthe
helpful
for us of
to the
determine
as much
about
ourform.
customer’s business as possible.
We would appreciate your cooperation in the completion of the appropriate section of this form.
WHICH OF THE FOLLOWING BEST DESCRIBES YOUR COMPANY
WHICH
FOLLOWING
BEST DESCRIBES YOUR COMPANY
(Place aOF
1 forTHE
primary
and a 2 for secondary)
(Place a 1 for primary and a 2 for secondary)
Design/Architecture
Design/Architecture
___ Architectural Firm
___ ___
Architectural
Firm Firm
Interior Design
___ ___
Interior
Design Firm
Kitchen/Bath
Design Firm
___ Kitchen/Bath Design Firm
___ General Contractor
___ Model Home Construction
OEM Manufacturer
Building/Construction
Building/Construction
___ Home Improvement Contracting Firm
___ Home Improvement
Contracting
Firm Firm
___ Kitchen/Bath
Remodeling
___ Kitchen/Bath___
Remodeling
Firm Firm
Custom Building
___ General
___ Custom Building
Firm Contractor
___ Model Home Construction
Retail/Wholesale
OEM
Manufacturer
Retail/Wholesale
___Custom
Cabinet Manufacturer
___ Antique Restoration/Refinisher
___Custom
Furniture
Manufacturer
___ Home Center
___Custom Cabinet Manufacturer
___ Antique Restoration/Refinisher
___Hotel
Furniture
___
___Custom Furniture Manufacturer
___ Home Center Decorative Hardware Retailer
___
Hospital
Furniture
___ Plumbing
Retailer
___Hotel Furniture
___ Decorative Hardware
Retailer
___
Retail
Display
Furniture
___
Lumber
Yard/Building
Supply
___ Hospital Furniture
___ Plumbing Retailer
___ Retail Display Furniture
___ Lumber Yard/Building Supply
revised 8/1/11
___ Other: _____________________________
___ Other: _____________________________ revised 8/1/11
Please
this completed
form,
alongwith
with aacopy
of one
document.document.
Please return
thisreturn
completed
form,
along
copy
of business**
one business**
Mail to: 1801 Van Dyke Drive, Mitchell, SD 57301
Mail to: PO
101
Box
West52,
Coats
Louisiana,
St., Floor
MO
3,63353
Moberly MO 65270
Fax: 605-996-2069 Email: nancy.amberg@vandykes.com
Fax: 800-477-8271 Email: wholesale@vandykes.com