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Composite Drivelines LLC New Distributor Application

General Information

What Other Product Lines Do You Carry?

Dana / Spicer Neapco American Axel Other

How Did You Find Us?

Referral by another drive line shop Research on the web Other

Other ( If Applicable )

Reason You Are Soliciting Us To Sell Our Product Line.

Company Information

Company Legal Name

DBA Name If Applicable

Company Phone Number

Website

Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Shipping and Receiving Information

First Name

Last Name

Email

Preferred Method of Shipment

Shipping Account Number ( If Applicable )

Special Shipping Instructions?

Credit Application

Type of Business

Corporation Sole proprietorship Other Partnership LLC

Date Business Commenced

Name of Your Bank

Bank Fax Number

Bank Phone Number

Your Banker's First Name

Your Banker's Last Name

Type of Bank Account

Account Number

Trade References

Trade Reference #1 Name

Phone Number

Email

Address

Trade Reference #2 Name

Phone Number

Email

Address

Trade Reference #3 Name

Phone Number

Email

Address

PLEASE UPLOAD YOUR COMPANY’S SALES TAX EXEMPTION AND W9 FORMS

Wisconsin Sales and Use Tax Exemption Certificate

please download form and upload completed form below or email to info@compositedrivelines.com

W9 (if applicable)

Wisconsin Sales and Use Tax Exemption Certificate

Sales Tax Expemption (if applicable)

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Composite Drivelines LLC

11133 W Rogers St

West Allis WI 53227