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ATA MEMBER
Procain Company
P.O. Box 878
Fogelsville, PA US 18051
(877) Pro-Buck
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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