Thunderball Marketing Inc.
Combined Dealer Application
&
Master Purchase Agreement

To become a Thunderball dealer you may
 fill this form out on-line
 (PLEASE SUBMIT THE FORM AT PAGE BOTTOM)
 OR mail or fax this back to us, (get a fax & printer formatted form here)
If you need more space please use this form here
 (If you want to save this form use the "File> Save as" function of your browser.)

In the box below is your Status Tracking Number.
 Please copy this number (exactly) so you may track
the status of your application later at this link


Application Type Requested By You The Dealer:

A. Credit and Statistical Information:

Your Company Name:
Street Address:
City: State: Zip:
Phone: Fax:
E-mail: Web Site URL:
State Resale Certificate Number: Date of issue:
Federal Employer Identification Number:
Name of Accounts Payable Manager:
Company is: 
If corporation, what is the date of incorporation?
Date business was started?
States in which applicant does business:

B. Your Company Ownership Information:

1. First Name: Middle: Last:
Street Address:
City:State:
Country: Zip:
Phone: Social Security Number:
2. First Name: Middle: Last:
Street Address:
City:State:
Country: Zip:
Phone:   Social Security Number:

C. Supplier and Trade References::

Please list your major line suppliers or other trade references:
Supplier Account Number:
Supplier: Supplier Contact:
Street Address:
City: State:
Country: Zip:
Phone: Fax:
Supplier Account Number:
Supplier: Supplier Contact:
Street Address:
City: State:
Country: Zip:
Phone: Fax:

(If you require more space, please attach separate page..)

D. Bank reference information:

Bank Account Number:
Bank:Bank Contact:
Street Address:
City:State:
CountryZip:
Phone:  Fax:

Please indicate authorized buyers for your company

Buyer Name:    Title

Signature (“Buyer”)______________________


Second Buyer Name:   Title

Signature (“Buyer”)______________________ 
ACCEPTED:
THUNDERBALL MARKETING, INC.
By:__________________________

Title:__________________________

Date: ___________________________

Account Representative:______________________
Your New Account Number:____________

To speed your order, please use your account number when ordering. Thank you.

The above information is to be used for the express purpose of being established as a dealer with Thunderball Marketing, Inc.. Thank you for your cooperation.

Signature of Principal:_________________________

Print Name:

Please submit below and forward A SIGNED copy of this information immediately to: Fax (212) 645-6561


Alan 

Thunderball Marketing Inc.
10 Cragwood Road
Avenel, NJ,  07001

Phone: (212) 645-5600   Fax (212) 645-6561

 


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