Dealer Application Form

Company Name *

Billing Address *

Billing Address

City

State/Province

Zip/Postal

Country

Shipping Address *

Shipping Address

City

State/Province

Zip/Postal

Country

Phone *

Fax

Email *

Type of Ownership *

Sole

Partnership

Corporation

OtherOther

Parts Manager *

Accounts Payable Manager *

Business Description

Email Address for Invoices *

Length of Time in Business *

Tax Exempt ID# (Fax copy of Certificate of Resale) *

Trade References

Name *

Address

City

State/Province

Zip/Postal

Country

Address

City

State/Province

Zip/Postal

Country

Phone *

Fax

Bank Reference

Bank Name *

Phone *

Contact *

Fax

Sign Here

Completed By *

Title *

Date *

Terms: All invoices are 1% 10 days, net 10th. Should Agri deem it necessary to turn your account over for collection or legal action, the purchaser agrees to pay in addition to late charges in the amount of 1.5% per month the cost of collection and/or legal fees not to exceed 50% of the sum due.

Shipping: Orders are shipped same day by UPS unless instructed otherwise.

Quick Order Form

BEARINGS & SEALS

IMPLEMENT PARTS

OEM EQUIPMENT