Ontrion.com - Application for Distributorship

Geographic Information	*City		*Zip-Code
Geographic Information	*State		*Country
*Legal Name and DBA (if any)
Phone, Fax, Email, Website	*Phone		Fax:
Phone, Fax, Email, Website	*Email		Website:
Shipping Address, City, State, Country
Tax ID, Resale Permit, D&B, BBB Number	Federal Tax ID (US Only):		Resale CFT (Texas Only):
Tax ID, Resale Permit, D&B, BBB Number	D & B:		BBB Number (if any):
Business Start Date:	Select one or more from the following: Corporation Partnership Sole Proprietorship Agent Distributor Reseller		Type of Business: Number of Locations: Office Warehouse Own Rent
Business Start Date:	Number of Employees:		Store Front
Primary Contact Person	Name:	Email:	Phone:
Primary Contact Person	Name:	Email:	Cell Phone:
Corporate Officer	Name:		Title:
	Social Security Number:		Driver License:
			Direct Phone Number:
Trade Reference 1	Contact Name:	Phone Number:	Company Name:
Trade Reference 2	Contact Name:	Phone Number:	Company Name:
Bank Information	Name of Bank Officer:	Account Number:	Address of Bank:

               Blutron Group LLC dba OnTrion, 13650 T.I. Blvd #309, Dallas, TX 75243, USA
                Main Phone: +1(972) 497-9933; FAX: +1(972) 497-9934;  www.ontrion.com