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Dear Sir/Madam,
          In regards to your request for a catalog & price list of our products, please complete the following. The reason we need this information is that we can only sell to qualified resellers. This information is important to make it fair for our existing customers. If you require hardware for your own use, please contact one of our dealers in your area. If you operate a resale outlet , please complete the following information, and a catalog & price list will be forwarded to you promptly.

Thank You,
Harness Hardware Inc.


Business Name:
Address:
City/Town:
Province/State:
Postal Code:
Telephone:
Fax: *enter fax number without dashes
Email:
Owner's Name
Vendor Permit/Tax Number
Partnership Proprietorship
How long in business at this location ?
Do you operate a retail outlet from this location?     
N o
If yes, out of where do you operate your business? 
Store Home
Approximate inventory value you carry  
Nature of business
What type(s) of our products are you mainly interested in
Signature   By checking this box you authorize this digital signature

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