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POSTEN STABILIZATION DEALER REQUEST APPLICATION
PLEASE PRINT, COMPLETE, AND RETURN.
www.jimposten.com * jimposten@yahoo.com
803 Shady Lane. Tecumseh, MI 49286
517-403-9936
SHOP NAME
ADDRESS
CITY/STATE/ZIP
PHONE/FAX/EMAIL
WEBSITE
WHICH BEST DESCRIBES YOUR SHOP (CIRCLE ALL THAT APPLY)
STOREFRONT / HOME BASED / INTERNET / SERVICE & REPAIR / INDOOR RANGE / OUTDOOR RANGE
OTHER SHOP DESCRIPTION AND COMMENTS
DESCRIPTION OF SHOP SERVICES AND PRODUCT LINES CURRENTLY CARRIED
TAX ID#
DO YOU ADVERTISE? YES / NO DESCRIBE:
INITIAL ORDER DESCRIPTION
(LIMITED TIME ONLY MINIMUM $300 INITIAL ORDER)