| STEP 2. Please complete this form and fax it to us at 760-804-0970
AUTO PILOT AUTHORIZED DEALER PROGRAM
.
How it works:
1. 100% will be billed when the product lands in
the U.S., product ships out shortly after.
2. By signing this agreement, you are agreeing
to accept all of our retail store offers.
3. Your maximum allocation is 1 case per store
per offering.
4. Product in non-returnable.
5. You may receive multiple series per month.
6. You may cancel at any time, but only before
published offerings.
7. California sellers must include their resale
number on the form.
8. Check one of the following:
I have a store location__________
I am a show promoter of non-store dealer__________
(We use this for referral purposes, we don't want to
be sending people to your personal residence)
I Agree to Collecticritters Auto Pilot Program:____________________________________
Authorized Owner Signature
Date:______________ CA Resale #_____________________________
Billing Information:
Name:_____________________________Company_____________________________
Address:_______________________________________________________________
City:______________________________ State:______ Zip:_____________
Country:_____________Phone(____)_______________Fax(_______)_______________
E-Mail:______________@__________ Website:www.___________________________
************************************************************************
Payment Information Card #1:
Full Name on Credit Card:___________________________________________________
Card Type: VISA_____ M/C_____ AmEx_____
Credit Card #_______________________________________ExpDate:____/_____
Zip Code for Credit Card Bill:_______________
Signature:_______________________________________________________0_______
************************************************************************
Payment Information Card #2:
Full Name on Credit Card:__________________________________________________
Card Type: VISA_____ M/C_____ AmEx_____
Credit Card #_______________________________________ExpDate:____/_____
Zip Code for Credit Card Bill:_______________
Signature:______________________________________________________________
************************************************************************
Please fill out this form, sign and date it and FAX
to 760-804-0970 or
Mail To: Classic Collecticritters, Inc., 5145 Avenida Encinas #D, Carlsbad, CA 92008/font> |