Neon Design A-Sign® Dealer Application Form
To receive information about becoming a Neon Design A-Sign® Authorized
Dealer. Please print out this form at your location, fill in the information and fax it
to 949-348-1736 then mail it to Neon Design A-Sign.
After receiving your information, we will contact you with Dealer Pricing.
CONTACT NAME:__________________________________________
COMPANY NAME:__________________________________________
STREET ADDRESS:__________________________________________
CITY:________________________
STATE/PROVINCE:________________________
ZIP/POSTAL:________________________
COUNTRY:________________________
TELEPHONE:(_______)_________________________________
FAX:(_______)_________________________________
E-MAIL:__________________________________________
Please state the geographic area (City, County, etc.)
that you can realistically service with direct sales:
__________________________________________________________
__________________________________________________________
Existing businesses provide this additional information:
ACTIVITY OF BUSINESS:____________________________________
YEAR BUSINESS STARTED:______________
NUMBER OF EMPLOYEES:______________ RESALE NUMBER:__________________
SIGNATURE:_________________________ DATE:____________
NAME PRINTED:_________________________ TITLE:___________
NEON DESIGN A-SIGN, mfg. 26022 Cape Drive, Bldg. H Laguna Niguel, California, USA
92677
Phone: 949-348-9223 / Fax: 949-348-1736 E-mail: sales@neon-das.com / Internet:
www.neon-das.com
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