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Phone : 404-702-3599

Email : distributorsangel@yahoo.com

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Distributors Application

Home Distributors Application

MAXTEL WIRELESS
Billing:-5992 Mayfield view dr, Tucker,GA 30084
Shipping:-2500 Royal place, Tucker, GA 30084
Phone-404-702-3599, fax 678-694-1700
Distributors Application  Form

 Company Name:_________________________Phone:____________________________
 D.B.A _______________________________Fax: ______________________________
 Address:______________________________Cell:________________________________________________________
 __________________________________
Email:____________________________
 Business Type:__________________________________________________
Billing adress:__________________________________________________
 Years in Business_____________________
 Tax. I.D #_____________________________Payable Contact name:___________
 Owners name____________________________Phone:____________________ Home Phone:____________________________ Fax:_____________________
 
Owner/Corporate Information(Please provide complete names,titles,address,phone#)
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
 
                                                Please provide Trade References(minimum 2)
Trade Reference #1                                                                                           
Company:_______________________________
Contact:  _______________________________
Account#:______________________________
Phone#: _______________________________
Address:  _______________________________
Trade Reference #2
Company:                                   _______________________________
Contact:                                     _______________________________
Account#:                                 _______________________________
Phone#:                                   _______________________________
Address:                                     _______________________________
 
Please FAX at 678-694-1700 or email  SANDY at  info@maxtelwireless.avonz.us

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