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| To access
the Wholesale/Special Pricing fill out the following information form:
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Required
entries are marked with an "*" |
| Company
Name: |
* |
| Address Line
1: |
* |
| Address
Line 2: |
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| City: |
* |
| State: |
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| Postal Code: |
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| Country |
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| Contact First
Name: |
* |
| Contact
Last Name: |
* |
| Contact
Title: |
* |
| Email
Address: |
* |
| Confirm
Email Address: |
*
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| Phone Number and Extension: |
* |
| Fax Number: |
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| Type Of Entity: |
* |
| Federal ID
#: |
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| Type of Business: |
* |
| Type of Products
Sold: |
* |
Questions or Comments:
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IMPORTANT NOTICE: ila reserves the right to deny a wholesale distributorship for any reason that leads it to believe, in its sole discretion, that such distributorship would not be in the best interest of ila . ila further reserves the right to terminate a wholesale distributorship immediately for cause or with 30-days advance notice for any other reason or “non-cause”. Prices are subject to manufacturers' adjustments, but our customers will be notified of increases before orders are shipped so that they can choose whether or not to purchase at the new price.
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I have read this agreement and agree to all of the conditions contained above. |
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