Dealer Application

Please Note: This is not an application for credit.

Company Name
Email Address
Mailing Address
Mailing City
Mailing State/ZIP
Shipping Address
(if different than above)
Shipping City
Shipping State/ZIP
Is this a subsidiary of a parent company? Yes       No
If yes, please provide information about the parent company:
Parent Company Name
Parent Company Address
Parent Company City, State and Zip
COMPANY INFORMATION
Sales Manager's Name
Accounts Payable Manager's Name
Number of Employees Number of Salespeople
Which best describes your primary market?
If other, please specify:
Manufacturers whose products you are an Authorized Dealer for (please check all that apply): Bretford
Da-Lite
Draper
Stewart
If other, please specify:
Please list three nationally known Audio Visual Companies or Products that you are currently an Authorized Dealer for:
Company
Phone
Fax
Company
Phone
Fax
Company
Phone
Fax
MD State (Resale) Sales Tax ID Number
Do you belong to any of the following trade organizations? Infocom
Cedia
Other
If other, please specify:
 
HURLEY SCREEN . 110 Industry Lane . Post Office Box 296 . Forest Hill, MD 21050
Tel: 410.879.3022   -   Toll Free: 877-487-4912   -   Fax: 410.838.8079

HURLEY SCREEN
A subsidiary of CEMCORP
 110 Industry Lane
Post Office Box 296
Forest Hill, MD 21050
 Tel: 410.879.3022
Toll Free: 1-877-487-4912
Fax: 410.838.8079
 -Email us