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Revita Apiserum Dr Nobis Skin Care, Reseller Application Forms

By Sheila Daniels,2014-05-12 21:29
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Revita Apiserum Dr Nobis Skin Care, Reseller Application Forms

    YinPo Global Media, Inc.

    www.Soft.YinPo.com

    Cloth Electrodes for Muscle Stimulators (TENS, EMS, etc.)

159 Koch Road, Corte Madera, CA 94925, USA

    Tel : 4 1 5 9 2 4 0 6 0 6 , Sophia Yu, Fax : 2 1 5 8 9 5 9 8 1 6

    soft@YinPo.com

    New Dealer Resell Permit Information

    To Print the forms please go FILE then Click on PRINT

    RESELLER NAME___________________________________________________________

    BUSINESS NAME____________________________________________________________

    ADDRESS____________________________________________________________________

    Tax ID ______________________________Business Type _________________________

Tel. ______________________Fax __________________

    Website : _______________________________ Email ___________________

I HEREBY CERTIFY:

    That I hold valid Reseller's Permit No. _______________issued by ______________________ issued pursuant to the Sales and Use Tax Law; that I am engaged in the business of selling

_____________________________________________________________________________; that the tangible personal

    property described herein which I shall purchase from:

     YinPo Global Media, Inc

will be resold by me in the form of tangible personal property; provided, however, that in the event any of such property is

    used for any purpose other than retention, demonstration, or display while holding it for sale in the regular course of

    business, it is understood that I am required by the Sales and Use Tax Law to report and pay tax, measured by the purchase

    price of such property or other authorized amount. Description of property to be purchased.

Cloth Electrodes for TENS, EMS, inc.

     Title

     (Signature of Purchaser or Authorized Agent)

Print your name

Date

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YinPo Global Media, Inc.

www.Soft.YinPo.com

    Cloth Electrodes for Muscle Stimulators (TENS, EMS, etc.)

     159 Koch Road, Corte Madera, CA 94925, USA

    Tel : 4 1 5 9 2 4 0 6 0 6 , Sophia Yu, Fax : 2 1 5 8 9 5 9 8 1 6

    soft@YinPo.com

    BILLING ADDRESS BANKING REFERENCE

CONTACT CONTACT COMPANY NAME COMPANY NAME ADDRESS ADDRESS CITY/STATE/ZIP CITY/STATE/ZIP PHONE PHONE

    SHIPPING ADDRESS if different from billing TRADE REFERENCE

CONTACT CONTACT COMPANY NAME COMPANY NAME ADDRESS ADDRESS CITY/STATE/ZIP CITY/STATE/ZIP PHONE PHONE

    TRADE REFERENCE TRADE REFERENCE

CONTACT CONTACT COMPANY NAME COMPANY NAME ADDRESS ADDRESS CITY/STATE/ZIP CITY/STATE/ZIP PHONE PHONE

Payment :If paid by credit card number, please fill out the info below :

I, __________________ _, the credit card holder authorize all purchase to be

    charged on my Credit Card account ___________________________, Expiration ________ by YinPo Global Media, Inc. the Vendor. Thank you.

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    By Dealer / the Buyer Date

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