Our Clients/Customer Information Form

Become a Dealer

Become a Dealer

Term 2016 - 2017 must be filled out completely and printed on company letterhead in order to be processed)

San Dimas,USA

help@americanpro.com
+1 909 599-5533

Name of entity:*
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Address Of Your Main Location or Headquarters:*
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Years in Business:*
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Website address:
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Main email address:*
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Worldwide Locations of Your Branch Offices*
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A list of worldwide country locations or places where you ship the goods (Final Destination).
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Names and titles of entity’s ultimate parent company and individuals with controlling ownership:
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Names of entity’s subsidiaries if any
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Names of Entity’s Directors, Senior Management, CFO/CEO, President, Treasurer, General Managers :
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Contact person, phone and fax of Three Business References (e.g. Other U.S. Companies):
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Record of any Penalties or Proceeding Under U.S Export or Sanction Laws:
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Any other relevant information :
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