Distributor Application

BALLOON INNOVATIONS INC.
DISTRIBUTOR APPLICATION

(Not a Credit Application).

COMPANY INFORMATION
Company Name*
Owner's Name*
Physical Address*
City*
State*
Zip*
Billing Address If different from above
Contact Name *
Phone Number *
Mobile Number
Fax
Email Address*
Website
Year Business Started*
Type of Business (i.e. Corp., Partnership, Sole Proprietorship)*
Federal Tax ID *
Current Estimated Annual Sales *
Description of Services/Products Currently Provided*
Description of Targeted Geographical Area For Direct Solicitation/Marketing of Products*
Geographical Area For Direct Solicitation/Makrketing of Balloon Innovation Inc
Describe Targeted Geographical Area(s) For Internet Sales of Balloon Innovations Inc. Products if applicable:
Methods of Selling From Most Important to Least (i.e. Catalog, Website, Company Vans) *








How Did You Hear of Us? *
Explain Why You Would Like to Distribute Balloon Innovations Inc. Products/Services? *
Have You Sold Similar Helium-Free Plastic Balloon Products In the Past? Explain *
SUPPLIERS INFORMATION

Please List Four Current Suppliers:

*Note: This information is not for credit purposes but will be used to determine the classification of your business since we deal with a wide variety of business types from ASI distributors to gas suppliers. If approved as a distributor for Balloon Innovations Inc. products/services a separate credit application may be necessary as well.

Supplier Name
Telephone
Address
Fax
City/State/Zip
Years/Months Associated
Products Supplied
Supplier Name
Telephone
Address
Fax
City/State/Zip
Years/Months Associated
Products Supplied
Supplier Name
Telephone
Address
Fax
City/State/Zip
Years/Months Associated
Products Supplied
Supplier Name
Telephone
Address
Fax
City/State/Zip
Years/Months Associated
Products Supplied
Are you human?

Thank You For Submitting! Please allow up to 2 weeks for a response.

We Look Forward to Working With You!!