Amtel Security Systems: Dealer Credit Application

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General information
Company Name * :
Parent Company * :
Affiliate Company(s) * :
Street Address * :
City * :
State :
Country * :
Zip Code * :
Phone * :	Dial Code:	Phone #:
E-Mail * :
Fax# :
Location :	Own Rent Home Commercial
Type of business * :
In business since :
Annual Sales :
D&B# :
Principal Officers
Name (1) * :
Social Security :
Capacity * :
Name (2) :
Social Security :
Capacity :
Trade References
Name (1) :
Phone#/Fax :
Contact/Title :
Name (2) :
Phone#/Fax :
Contact/Title :
Name (3) :
Phone#/Fax :
Contact/Title :
Bank Information
Name :
Phone/Fax :
Contact/Title :
Acct# :
Account Type :
Have you worked with :	Access Control Systems Parking Revenue Control Systems RF-ID & CCTV Based Security Systems Fleet Monitoring Systems GPS Based Wireless Asset Tracking Systems
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Dealer Credit Application Form

Authorized Dealer Credit Application Form

If you wish to become an authorized dealer for AMTEL's products, kindly fill out the form below and submit it. The fields marked (*) are required.