Hypro Therm Mfg LLC
1148 Hwy 62 West 
Salem, Arkansas 72576
 
 

We must receive all of the following from your company to
Qualify for Dealer pricing:
1) A completed Dealer Application.
2) Copy of business or resale license.
3) Arkansas dealers must fill out Resale Tax Form and fax current
copy of tax permit.
4) A photograph of your business faxed or e-mailed to us.
5) A copy of your yellow pages ad or copy of a business card.

 Payment Terms:
HYPRO THERM  does not offer open account terms.
Payments must be made via: Credit Card (3% surcharge); Wire Transfer;  Cashier Check; or Money Order before delivery.
 
HYPROTHERM FURNACE Dealer Application

GENERAL INFORMATION


Business Trade Name (if a DBA)


Business Legal Name (as it appears on business license)


Street

 
City                                                                      State                                Zip Code
Complete Business Address

    /   
Business Phone                             FAX Number                  


Street

 
City                                                                      State                                Zip Code
Billing Address (if different)                                    


Street

 
City                                                                      State                                Zip Code
Shipping Address  (if different)                                     


Officer/Owner Name                                                                                      Title


Officer Two/Co-Owner Name                                                                        Title

DESCRIPTION OF BUSINESS

This company is a (Check one)   Sole Proprietorship    Partnership   Corporation

Are You a franchise dealer for a major manufacturer (any business)? 

If so, what manufacturers        

Incorporated in the State of  

Length of time operating under the above name:   YEARS

Length of time at the above address:  YEARS

Number of Branches/outlets operated/managed by you:  

Website Address  

E-Mail Address  

INDUSTRY REFERENCES
(Must be suppliers that are actively distributing related industry parts to your business in the past 12 months; preferably in the U.S.A.- any industry))


Business Name, Address, City, State, Zip                                                    Phone #             Fax #                    Account #


Business Name, Address, City, State, Zip                                                   Phone #              Fax #                    Account #


Business Name, Address, City, State, Zip                                                     Phone #             Fax #                    Account #

TAX EXEMPTION INFORMATION (ARKANSAS DEALERS ONLY)

COPY OF CERTIFICATE MUST BE FAXED TO (870) 895-3111

Exemption Claimed (MUST select one)

Resale      Federal Government      Exempt Organization     State and Local Government     Other

Product or Service Rendered: 

General Description of products to be purchased by the seller: 

Certificate ID Number:  

Name and Title of Applicant: