Distributor Application Form

Stevens  Appliance  Truck  Company
Manufacturers of the famous ESCORT Appliance Trucks

PO Box 897     Augusta, GA 30903-0897
Phone: (706) 798-8535     TOLL FREE 1-888-463-8757    FAX: (706) 798-4511
www.StevensMFG.com       E-Mail:
Info@StevensMFG.com
Firm Applying Owner's Name
Address
City ST Zip
Phone FAX
E-mail
Business Type Years in Business
Contact Person for Shipping Shipping Person Phone
Contact Person for Ordering Shipping Person Phone
Contact Person for Billing Billing Person Phone
D & B Rating: and at least 5 Credit References:
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Credit terms are % cash -10 days,  Net 30 days.   A service charge of 1 % per month will be charged on the unpaid balance on accounts not paid within 30 days.   Shipments will not be made to distributors whose accounts are past due.

YEARLY PURCHASES ARE REQUIRED
TO MAINTAIN ACTIVE DEALER STATUS.

If you become a distributor for the Stevens Appliance Truck Company will you be willing to stock and promote the ESCORT line?   Yes    No

How many units do you anticipate you will be able to sell per year?
Initial order must be a minimum of 12 or 6 trucks.

Signature of Applicant (If submitting this Application via the Web, type your name here.)
Title  
You may Print this form by clicking on the Print Button of your Browser and mail or fax to Stevens at the address above.

Or, you may submit the completed form by e-mail by clicking the "Submit" button here...
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