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23047 N 15th Lane Phoenix, AZ 85027 (623) 465-5263 (623) 742-7313-Fax

DEALER APPLICATION THANK YOU FOR YOUR INTEREST IN BECOMING ONE OF OUR DEALERS. WE RESERVE THE RIGHT TO ACCEPT OR DENY ANY DEALER APPLICATION. **We must have the following to process your application!! 1. Completed Dealer Application 2. Copy of Business License or Tax Permit or State License 3. Picture of your shop front and parts display(if not shown on your website)

JSSI requires a minimum first purchase order of $2000.00 We are here to help you with any questions you might have! Please don't hesitate to call us!

John Shope's Sinister Industries Dealer Application

Business Name:____________________________________ Street Address:___________________________________________

City:_____________________ State:___________ Zip: __________ Billing Address (if different): _____________________________________________________ Shipping Address (if different): ____________________________________________________ Store Phone Number: __________________ Fax:_______________ E-Mail Address:___________________________________________ Web site__________________________________________________ Type of Ownership (check one): __Individual __ Partnership __Corporation Name of Owner/Partner/Officer:_______________________________________ Method of Payment Accepted: ____Credit Card (Visa, MC, Discover)

Store Manager: ______________________________________________________________ Parts Manager: ______________________________________________________________ Bookkeeper: ______________________________________________________________ People Authorized to Purchase: ______________________________________________________________ Date Business Started?_________________________________________ Store Hours: Mon thru Fri _____ to _______ Sat______ to ______ Sun ______ to ______

Credit Card Authorization Form

Company Information: Company Name:_______________________________________________ Name as it appears on Credit Card:______________________________ Billing Address:_______________________________________________ City:________________________ State:______________ Zip:_______ Credit Card Information: Mastercard: _____ Visa_____ Discover_____ Card#________________________________________________________ Expiration Date: _________/______

I hereby authorize John Shope's Sinister Industries. to process my credit card for payment of products of services which I or my authorized representatives may order: ______All Orders ______This order only ______Other Authorized Signature: _______________________________ (Signature) _______________________________ (Print) __________ (Date) ____________________________ (Title)



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