Dealer Account Application Teton Dealer Application 0% Complete1 of 6 Header Dealer Account Application Chesbro Music Company P.O. Box 2009, Idaho Falls, ID 83403-2009 800.243.7276 Fax 208.522.8712 Company Address Legal Name of Company * dba Billing Address * City * State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip * Shipping Address * City * State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip * Company Info Company Type * Sole Owner Partnership Corporation LLC State of * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Federal Tax ID # * Phone * Fax Website E-mail Address * Names, titles & complete home address of all officers, owners or partners: Owner/Officer/Partner Name * Title * Home Address * City * State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip * Phone * Owner/Officer/Partner Name Title Home Address City State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip Phone Purchase Order number required? * Yes No Type of account desired: * Credit Card Payments Net 30/Open Payments C.O.D (Shipments are sent Credit Card or C.O.D pending credit approval) Bank Address Authorized Buyer(s) * Name of Bank * Bank Officer Address City * State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip * Bank Account and Contact Checking Account # Savings Account # Loan Account # Phone Fax Credit Line $ Business Sales Info Years in Business * Annual Gross Volume * List Brand Names of product you currently sell: * Type of Product: * Accessories Fretted Instruments Print Music Pro Audio Percussion Band Instruments Keyboards Gifts Hours open for Business Hours of Operation From * Sunday Monday Tuesday Wednesday Thursday Friday Saturday To * Sunday Monday Tuesday Wednesday Thursday Friday Saturday Opening Time * 121234567891011 : 0030 AMPM Closing Time * 121234567891011 : 0030 AMPM If you are human, leave this field blank. Go to Credit References
