Quickpoint
Distributor Application
Confidential Information
Applicant Name:
Firm Name:
Phone:
Fax:
Email Address:
Street Address:
City:
State:
Zip:
PPAI Membership #:
ASI Membership #:
Are you a:
proprietor partnership corporation?
Date Incorporated:
Specific Area Covered:
Annual Sales Volume:
Sales Volume in Ad Specialties:
Full-Time Salespeople:
Part-Time Salespeople:
If new, what organization
were you formerly connected?
Have you severed your connections?
Yes    No
When?
May we verify this?
 Yes    No
Do you subscribe to the ASI Service?
Yes    No
Managing Officer:
Title:
Home Address:
City:
St.:
Zip:
Approx. Net Worth:
 $
Sales Tax Exempt No.:
Officer/Owner:
Title:

 

Please list name and address of present PPAI Suppliers.

Name of Supplier:
 Annual Volume:
Address:
    
 
City:
 
 St.: Zip:    
Name of Supplier:
 Annual Volume:
Address:
    
 
City:
 
 St.: Zip:    
Name of Supplier:
 Annual Volume:
Address:
    
 
City:
 
 St.: Zip:    
Name of Supplier:
 Annual Volume:
Address:
    
 
City:
 
 St.: Zip:    
Name of Supplier:
 Annual Volume:
Address:
    
 
City:
 
 St.: Zip:    
Name of Supplier:
 Annual Volume:
Address:
    
 
City:
 
 St.: Zip:    
Name of Supplier:
 Annual Volume:
Address:
    
 
City:
 
 St.: Zip:    
Name of Supplier:
 Annual Volume:
Address:
    
 
City:
 
 St.: Zip:    


When you have completed this application, and have verified that all information is correct, please click "send" for the application to be forwarded to Quickpoint. We will process your application and respond to you as soon as possible.

Again, thank you for your interest in Quickpoint!