restorers acquisitioniinc. dba van dykes restorers i 1801tvan
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Restorers Acquisition Inc. DBA Van Dykes Restorers 1801 Van Dyke Drive, Mitchell, SD 57301 Tel: 605-996-2840 x108 www.vandykes.com
Wholesale Buying Application: Please complete this form to apply for wholesale status. Source:
All information supplied will be held in strict confidence.
COMPANY NAME: ____________________________________________________________________
ADDRESS: ____________________________________________________________________________
CITY/STATE/ZIP: ______________________________________________________________________
CONTACT PERSON: ___________________________________________________________________
BUSINESS TELEPHONE: ___________________________ BUSINESS FAX: _____________________
E-MAIL ADDRESS: __________________________________________ Please send me emails about special offers from Restorers Wholesale.
Please provide shipping address if different from the above address. ADDRESS: ____________________________________________________________________________
CITY/STATE/ZIP: ______________________________________________________________________
BUSINESS DOCUMENTATION **Required: PHOTOCOPY** Please attach a photocopy of one the following items to demonstrate the establishment of a business. All documentation must be in the name of the business with the address shown above.
_____Resale Tax Certificate ____Federal Tax Id
_____Business License
CUSTOMER PROFILE INFORMATION To best serve the needs of our customer, it is helpful for us to determine as much about our customer’s business as possible. We would appreciate your cooperation in the completion of the appropriate section of this form.
WHICH OF THE FOLLOWING BEST DESCRIBES YOUR COMPANY (Place a 1 for primary and a 2 for secondary) Design/Architecture Building/Construction ___ Architectural Firm ___ Home Improvement Contracting Firm ___ Interior Design Firm ___ Kitchen/Bath Remodeling Firm ___ Kitchen/Bath Design Firm ___ Custom Building Firm ___ General Contractor ___ Model Home Construction OEM Manufacturer Retail/Wholesale ___Custom Cabinet Manufacturer ___ Antique Restoration/Refinisher ___Custom Furniture Manufacturer ___ Home Center ___Hotel Furniture ___ Decorative Hardware Retailer ___ Hospital Furniture ___ Plumbing Retailer ___ Retail Display Furniture ___ Lumber Yard/Building Supply
___ Other: _____________________________ revised 8/1/11 Please return this completed form, along with a copy of one business** document. Mail to: 1801 Van Dyke Drive, Mitchell, SD 57301 Fax: 605-996-2069 Email: [email protected]
Restorers Acquisition Inc. DBA Van Dykes Restorers101 West Coats St., Floor 3, Moberly MO 65270
Tel: 800-495-9689 www.vandykes.com
Wholesale Buying Application:Please complete this form to apply for wholesale status. Source:All information supplied will be held in strict confidence.
COMPANY NAME: ____________________________________________________________________ADDRESS: ____________________________________________________________________________CITY/STATE/ZIP: ______________________________________________________________________CONTACT PERSON: ___________________________________________________________________BUSINESS TELEPHONE: ___________________________ BUSINESS FAX: _____________________E-MAIL ADDRESS: __________________________________________ Please send me emails about special offers from Restorers Wholesale.
Please provide shipping address if different from the above address.
ADDRESS: ____________________________________________________________________________CITY/STATE/ZIP: ______________________________________________________________________
BUSINESS DOCUMENTATION **Required: PHOTOCOPY**
Please attach a photocopy of one the following items to demonstrate the establishment of a business. All documentation must be in the name of the business with the address shown above._____Resale Tax Certificate ____Federal Tax Id_____Business License
CUSTOMER PROFILE INFORMATIONTo best serve the needs of our customer, it is helpful for us to determine as much about our customer’s business as possible. We would appreciate your cooperation in the completion of the appropriate section of this form.
WHICH OF THE FOLLOWING BEST DESCRIBES YOUR COMPANY(Place a 1 for primary and a 2 for secondary)
Design/Architecture Building/Construction___ Architectural Firm ___ Home Improvement Contracting Firm___ Interior Design Firm ___ Kitchen/Bath Remodeling Firm___ Kitchen/Bath Design Firm ___ Custom Building Firm___ General Contractor___ Model Home Construction
OEM Manufacturer Retail/Wholesale___Custom Cabinet Manufacturer ___ Antique Restoration/Refinisher___Custom Furniture Manufacturer ___ Home Center___Hotel Furniture ___ Decorative Hardware Retailer___ Hospital Furniture ___ Plumbing Retailer___ Retail Display Furniture ___ Lumber Yard/Building Supply___ Other: _____________________________ revised 8/1/11
Please return this completed form, along with a copy of one business** document.Mail to: 101 West Coats St., Floor 3, Moberly MO 65270Fax: 800-477-8271 Email: [email protected]
Restorers Acquisition Inc. DBA Van Dykes RestorersPO Box 52, Louisiana, MO 63353
Tel: 800-495-9689 www.vandykes.com
Wholesale Buying Application:Please complete this form to apply for wholesale status. Source:All information supplied will be held in strict confidence.
COMPANY NAME: ____________________________________________________________________ADDRESS: ____________________________________________________________________________CITY/STATE/ZIP: ______________________________________________________________________CONTACT PERSON: ___________________________________________________________________BUSINESS TELEPHONE: ___________________________ BUSINESS FAX: _____________________E-MAIL ADDRESS: __________________________________________ Please send me emails about special offers from Restorers Wholesale.
Please provide shipping address if different from the above address.
ADDRESS: ____________________________________________________________________________CITY/STATE/ZIP: ______________________________________________________________________
BUSINESS DOCUMENTATION **Required: PHOTOCOPY**
Please attach a photocopy of one the following items to demonstrate the establishment of a business. All documentation must be in the name of the business with the address shown above._____Resale Tax Certificate ____Federal Tax Id_____Business License
CUSTOMER PROFILE INFORMATIONTo best serve the needs of our customer, it is helpful for us to determine as much about our customer’s business as possible. We would appreciate your cooperation in the completion of the appropriate section of this form.
WHICH OF THE FOLLOWING BEST DESCRIBES YOUR COMPANY(Place a 1 for primary and a 2 for secondary)
Design/Architecture Building/Construction___ Architectural Firm ___ Home Improvement Contracting Firm___ Interior Design Firm ___ Kitchen/Bath Remodeling Firm___ Kitchen/Bath Design Firm ___ Custom Building Firm___ General Contractor___ Model Home Construction
OEM Manufacturer Retail/Wholesale___Custom Cabinet Manufacturer ___ Antique Restoration/Refinisher___Custom Furniture Manufacturer ___ Home Center___Hotel Furniture ___ Decorative Hardware Retailer___ Hospital Furniture ___ Plumbing Retailer___ Retail Display Furniture ___ Lumber Yard/Building Supply___ Other: _____________________________ revised 8/1/11
Please return this completed form, along with a copy of one business** document.Mail to: PO Box 52, Louisiana, MO 63353Fax: 800-477-8271 Email: [email protected]