Worldwide Cycling Solutions Through Creative Innovations.

310 LAKE STREET, OAK PARK, IL 60302 U.S.A.
Phone 708-383-5541  /  Fax 708-383-5334  /  Email shipbikesorders@yahoo.com

Credit Information must be filled out completely. Download PDF Application

Name of company _____________________________________
Owner of company _____________________________________
Ship to address ________________________________________
City _________________________________________________
State __________________ Zip Code _____________________
Phone Number _____________ Fax Number _______________
Email _______________________________________________
Size of store square footage ____________________________

Bank name ___________________________________________
Phone number ________________________________________
Checking account number _____________________________
Federal ID number ___________________________________
State Resale ID number ______________________________

Credit references
No.1 _________________________________ Phone number: ________________
No.2_________________________________ Phone number: ________________
No.3 _________________________________ Phone number: ________________

As of September 23, 2012 any UNAUTHORIZED agent selling AirCaddy products by mail-order or through the Internet will be terminated.

Signature ___________________________________________

Print full name _____________________________________

Date _____________________      (____-____-____-____)

Print, Complete, and Mail, Fax, or Scan and Email your application.

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