SJE-Rhombus

SJE-Rhombus Distributor Application

SJE-Rhombus is a manufacturer who sells to authorized distributors who have supplied a resale certificate. If you would like to be qualified as an authorized distributor, please complete the application form listed below and forward a resale certificate to SJE-Rhombus. A SJE-Rhombus Customer Service Representative will process this application and contact you regarding volume pricing discounts available. If you would rather fax this form to us please print, complete and fax it to 218-847-4617. We look forward to working with you! This form must be completed in English.

This form must be completed in English.

 
Company Name: A value is required.
Billing Address: A value is required.
City: A value is required.
State or Country: A value is required.
Zip or Postal Code: A value is required.
Order Acknowledgement E-mail: A value is required.Invalid format.
Invoice E-mail: A value is required.Invalid format.
Phone: A value is required.Invalid format. (xxx) xxx-xxxx
Fax: A value is required.Invalid format. (xxx) xxx-xxxx
President/Owner: A value is required.
Company ID Number:
Number of years in business: A value is required.
Are you a reseller:

Please make a selection.
Number of Employees:
Business Type: Please select an item.
Anticipated annual sales volume (US dollars) of floats, alarms & panels: A value is required.
What industries do you currently supply:
Who do you currently sell to: Please select an item.
What products do you currently distribute:
Type of credit requesting: Please select an item.
Estimated monthly credit: A value is required.
   

Applying for a credit card account? Click Here


 Fill out this section only if the type of credit you are requesting is an Open Account or Prepayment.
Please provide bank refefrences:
Ful Bank Name:
Account Number:
Address:
City:
State or Country:
Zip or Postal Code:
Phone:
Fax:
E-mail:

Please provide trade references: (All three reference must be entered to complete this application)
  Reference #1
Company Name:
Contact:
Address:
City:
State or Country:
Zip or Postal Code:
Phone:
Fax:
E-mail:
   
  Reference #2
Company Name:
Contact:
Address:
City:
State or Country:
Zip or Postal Code:
Phone:
Fax:
E-mail:
   
  Reference #3
Company Name:
Contact:
Address:
City:
State or Country:
Zip or Postal Code:
Phone:
Fax:
E-mail:
Ship to Address: (for products that need to be shipped to a location different that the billing address provided above)
Name/Attn To: A value is required.
Phone: A value is required.Invalid format. (xxx) xxx-xxxx
Street Address: A value is required.
City: A value is required.
State or Country: A value is required.
Zip or Postal Code: A value is required.
Seciryt Verification: security code
Comments:
   

 

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