*First Name: *Last Name: *Company Name: *Address: *City: *State: *Zip: *Country: United States Canada *Phone Number: ( ) - - (Please include area code) Fax:( ) - - (Please include area code) SSN/Fed Tax ID #: (You are responsible for your own income tax) *Resale Permit ID #: e.g. SR AP (Character 4 to 6 digits) 97-197684 (Number 8 to 10 digits) Web Site (Optional) *Email Address: *Password you would like: (Case sensitive) *Confirm Password: Distributor Materials (Optional) Price: $225.00 (includes shipping charge) Kit Includes: Neon Color Sample LED Custom Sign With All Sample Colors One Complete Neon & Led Catalog w/ Wholesale Price List (Suggested Retail Price Mark Up 30% excluding "OPEN" sign)
Payment Information Credit Card *Card Type:American Express Visa MasterCard Discover *Credit Card Number: *Expiration Date(Month/Year): 010203040506070809101112 20102011201220132014201520162017201820192020 *Card Code # (at back): *Name as it appears on card: *Credit Card Billing Address: *City & State Zip Code: Other Payment Method: Money Order Personal Check You may also pay by Money Order or Check. Kit will be sent once payment has cleared. Make check payable to: Arter Neon Sign, Inc. Mail to address: 2028 Mountain View Rd. S El Monte CA 91733
Credit Card
*Card Type:American Express Visa MasterCard Discover *Credit Card Number: *Expiration Date(Month/Year): 010203040506070809101112 20102011201220132014201520162017201820192020 *Card Code # (at back): *Name as it appears on card: *Credit Card Billing Address: *City & State Zip Code:
You may also pay by Money Order or Check. Kit will be sent once payment has cleared. Make check payable to: Arter Neon Sign, Inc. Mail to address: 2028 Mountain View Rd. S El Monte CA 91733
