ProScreen, Inc
10 Crater Lake AvenueSte 19 Medford, OR 97504 US
Telephone:(541)779-7962 Fax: (541)779-6959

Thank you for your interest in ProScreen, Inc. products. To begin the process of becoming a certified AV Dealer for our products, please submit the application below, or if you prefer, download the following pdf file and fax to: 541-779-6959

ProScreen, Inc. Dealer Application

Applicant Information

Business Name:
Contact Name:
Address:
City:
State:
ZIP:
Phone:
Fax:
E-mail:
Web Site:
Years in business:
Business Type: If Other:
Number of Screens sold in the past 12 months:
List Installations:  
Bank References      
Bank Name: Average Balance:
Acct Number: Any NSF Check Problems:
Phone: Outstanding Loans:
how long at this bank: Loan Payments on time:
       
Trade References/list Suppliers
Company: Company:
Contact: Contact:
Years with Company: Years with Company:
Credit Line Limit: Credit Line Limit:
Terms: Terms:
       
Company: Company:
Contact: Contact:
Years with Company: Years with Company:
Credit Line Limit: Credit Line Limit:
Terms: Terms:

ProScreen Incorporated open account terms are as follows: All invoices Net-30; past due thereafter. All quantity terms and/or freight terms are dropped on past due invoices. Accounts past due will be subject to a finance charge of 19 % per month. Applicant’s signature attests financial responsibility, ability, and willingness to pay our invoices in accordance with the above terms. Applicant agrees to pay reasonable attorney’s fees plus interest in case of default in payment with above terms.

PLEASE INCLUDE MOST RECENT FINANCIAL STATEMENTS. FINANCIAL STATEMENTS ARE REQUIRED TO PROCESS THIS APPLICATION.

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