CONSUMER DEPOT
3332 Powell Avenue, Nashville, Tn 37204
Phone (615)851-2125 Fax (615)851-2126
DEALER SETUP FORM
Whenever possible, CONSUMER DEPOT offers re-seller pricing. In order to qualify, Please Print the form below and Fax it to us at above number. If you have already purchased from us, you have already been assigned a dealer number.

-Tennessee Dealers must provide a signed State Blanket Certificate of Resale.

-Non-Tennessee dealers must submit a copy of their state Sales and Use Tax Exemption Certificate via fax.
Company:
  
Contact Name:
  
Address:
  
Address2:
  
City/State/Zip
  
Phone:
                                              Fax:          
E-Mail:
  
Organization Type:
 Corporation                 Partnership                Proprietorship                LLC               
Tax ID#:
  
PAYMENT TERMS
COD Cash Order will ship immediately
Credit Card Must Complete Credit Card Authorization
COD Company Check

Company check terms may be established after credit verification. Bank Information must be provided.

BANK INFORMATION
(Must be completed to receive COD Company Check terms.)
Bank Name:
  
Bank Phone:
                                                             Contact:
Acct. #(s):
 
Bank Information Authorization
The undersigned authorizes the release of Banking and Credit information requested by Consumer Depot for the purpose of establishing COD Company Check terms as payment. This form may be reproduced or photocopied and faxed copy shall be as effective consent as the original, which I have signed.

SIGNATURE                                                                TITLE                                                               

DATE