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Agreement | Application | Credit Card Form | Procedure List

Reseller Application Form

If you are interested in becoming a Write Brothers international reseller, please fill out this short form.

It is necessary for you to complete each field (from your computer) and print out this entire document. Please mail or fax the entire document back to us with the rest of your application for reseller status.

General Company Information:

**Billing Address**
Company:
Attention:
Address:

City:
Postal Code:
Country:
Phone: (required)	Fax:
e-mail: (required)

**Shipping Address (If Different From Above)**
Company:
Attention:
Address:

City:
Postal Code:
Country:
Phone:

Your Business Profile:

Organizational Form:

Do you use Purchase Orders?

If yes, they must be written.

Number of Selling Locations:
Classify your business as:

Key Company Personnel:

President:
V.P
Controller
Accounts Payable:

Any other important personnel:

Authorization:

The statements and information provided in this application and in any attached documents are true and complete to the best of my knowledge. I also understand the following:

Information submitted in this guide will be treated discreetly by Write Brothers, Inc.

Inaccurate and/or false information may be grounds for Write Brothers to terminate any future contractual agreements.

Write Brothers , Inc. may contact any person or business outlined in this application for the purpose of verifying the information submitted. By sending this document I do hereby authorize any such person or business referenced herein to release any information via telephone, Fax, or mail to Write Brothers, Inc., which they require to effect such verification.

Applicant's signature attests to financial responsibility, ability, and willingness to pay invoices in accordance with agreed terms.

Incomplete applications will not be processed.

Name:
Title:
Date:

Agreement | Application | Credit Card Form | Procedure List