Wholesale Purchase Application

Wholesale Purchase Application

Please fill out this form to apply for wholesale purchase privileges. Incomplete forms will not be processed.

*First Name:

*Last Name:

*Title:

*Company Name:

*Company Type:

*Tax ID:

Company Website:

*Phone:

Fax:

*E-mail Address:

# of Employees:

# of Physical Locations:

*Annual Revenue:

Quantity:

*Products of interest:

CAFTek DDO-50

DC300 w/ Disc Manager 1.1

DC300 w/o Disc Manager 1.1

*Other Products:

*Please describe your company:

*How do you sell your products?:

Internet

Direct

Catalog

Flea Market

Vending Carts

Trade Shows

Telemarketing

Wholesale

Other

If 'Other', please specify:

*Preferred Payment Type:

Please add any additional comments: