K E N W O O D C O M M U N I C A T I O N S© Copyright 2006 e Commerce Supply Page 5DEALER APPLICATION(Easy On-Line Application Available at www.ecom-supply.com)Company Name ____________________________________________________________________ Date ______________________________Address/City/State/Zip ___________________________________________________________________________________________________Telephone _________________________ FAX _______________________ Web Address ___________________________________________Type of Business and Products Sold _______________________________________________________________________________________[ ] Corporation (State _________) [ ] S ole Proprietorship [ ] Partnership Years in Business ___________General Manager ____________________________________________________ Email Address _____________________________Sales Manager _______________________________________________________ Email Address _____________________________Accts Payable Contact _________________________________________________ Email Address _____________________________Tax Resale Number ___________________________________ Please provide a copy of your State Tax Resale Certificate with ApplicationPayment Type [ ] Major Bankcard [ ] COD *[ ] Net 30 Days (On Approved Credit with Opening Radio Order)* Please allow 5 to 10 working days to process an open account application. If product is needed immediately, orders can be shipped via UPS COD or paid with a bankcard (3% fee may apply).==========================================================================BANK REFERENCEBank ___________________________________________________ Telephone _________________________ FAX _______________________Address/City/State/Zip __________________________________________________________________________________________________Contact ______________________________________________________ Account Number _________________________________________==========================================================================SUPPLIER REFERENCESSupplier ________________________________________________ Telephone _________________________ FAX _______________________Address/City/State/Zip ___________________________________________________________________________________________________Contact ______________________________________________________ Account Number _________________________________________Supplier ________________________________________________ Telephone _________________________ FAX _______________________Address/City/State/Zip ___________________________________________________________________________________________________Contact ______________________________________________________ Account Number _________________________________________Supplier ________________________________________________ Telephone _________________________ FAX _______________________Address/City/State/Zip ___________________________________________________________________________________________________Contact ______________________________________________________ Account Number _________________________________________Authorized By ____________________________________________ Title _____________________________ Date ____________________KENWOOD MASTER PROTALK DISTRIBUTORe Commerce Supply15375 Barranca Pkwy H108Irvine, CA 92618-2209949-502-5588 949-480-0039 FAXwww.ecom-supply.comradios@ecom-supply.com