Application
100 Chase Park South, SUITE 102, HOOVER AL 35244
PHONE: (205) 985-4112
FAX: (205) 985-9228
E-MAIL: jhebert@officepartners.com
Company Address:
Mailing Address:
Name:
Address:
Address:
City, St, Zip:
City, St, Zip:
Phone:
Fax:
Owner:
Contact:
Title:
-------------- -------Monthly Average------- ---------------
Estimated Yearly Purchasing Volume:
Wholesale:
Direct:
Computer System:
Do you have a PC?
Yes
No
Email Address:
State Resale Certificate: State
Number
Banking Information:
References: (Three Required):
Name:
Vendor/Account#
Address:
Vendor/Account#
Vendor/Account#
City, St, Zip:
Vendor/Account#
Account#:
Vendor/Account#
Contact:
Phone:
Requirements for Membership
Be internet/e-mail capable.
Participate at some level in Catalog and Flyers.
Pay bills over the internet.
Provide a Letter of Credit or a CD with Assignment as security.
Monthly fee of $200/month when buying over $7,000 direct/month, $100/month when under $7,000/month.
Paperwork Required for Acceptance:
State resale certificate.
A copy of your W-9.
Current financial statement.
Finalized copy of this application.
Letter of Credit or CD.
Check for your first month dues.
For Delayed Entry Please Enter the Following
I would like to delay my entry until
.