bbi collectible

Dealer Form

To open an account, please fill out the following: (Item marked with * is mandatory) 2

Company Information

* Email:
* re-type email:
* Company name:
* Started business date:
* Contact Person - First name:
* Contact Person - Last name:
* Title:
* Address:
* City:
* State/Province:
* Country:
* Tel:
Fax:
Postal Code:
Resale Number:
Tax-ID:
Company Homepage URL (If any):
Comment:

Business Credit References

	Company Terms	Contact Person	Address	Tel #	Fax #	Credit Limit
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Terms and Conditions

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