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ATA   MEMBER


Procain Company
P.O. Box 878
Fogelsville, PA US 18051

(877) Pro-Buck
 
http://americasbestcompanies.com
DEALER APPLICATION

Please read and complete the follwing: Distributor Application, Terms and Conditions, and Distribution Agreement.

Click here for a printable version of this order form.

Dealer Agreement


    This Agreement is made and entered into this   day of , by and between Procain LLC, a Pennsylvania Limited Liability Company (the "Company") and (hereinafter called "Dealer")




Click here to read TERMS I agree to the terms I disagree to the terms



  IN WITNESS WHEREOF, the parties have each executed this Agreement as of the date and year first above written.



“Company” PROCAIN LLC, a Pennsylvania Limited Liability Company
By: (SEAL)
Name:
Title:
 
“Dealer”
[ Company Name Above]
By: (SEAL)
Name:  
Title:
Address:
City: State: Zip:
 
Exhibit "A" [Products]:
Exhibit "B" [Territory]:

* Check here for agreement and electronic signature.
 

*Required
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