Distributor Application
Please complete the form below. The results will be emailed to ENPAC for review. Please also send 2 sets of company literature, annual report and/or product line brochure/catalog, along with trade references and a copy of your Resale Certificate with this completed form.
You will be able to print this completed page after submitting the form.
Referred To Enpac By
Area of Interest
(Check all applicable)
Overpacks
Spill Containment
Gas Cylinder
Other
Company Name
Billing Address
Billing City, State & Zip
Shipping Address
Shipping City, State & Zip
Accounts Payable Contact
Purchasing Contact
Sales Contact
Customer Service Contact
Email Address
Telephone
Telefax
Preferred Carrier
D&B Number
Rating
Organization Size/
Number of Employees
Approximate Warehouse Size
Branch Locations
Geographic Areas Served
Telemarketing?
Yes
No
Direct Sales
Yes
No
Number of Salespeople
Business Is (Corporation, Partnership, Proprietorship)
Name of Owner or Principal
Credit References
(List at least 3 with company name, city/state/zip, telephone and fax number)
Credit Reference 1
Credit Reference 2
Credit Reference 3
Bank Name
Bank Contact
Bank City/State/Zip
Bank Telephone
Catalog?
Yes
No
Publication Dates
Close Dates
Number in Circulation
Preparer's Name
Preparer's Title
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