Dropship Fulfillment Ctr: ACCOUNT APPLICATION

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NOTE: If you already have an account with DSDI™, please login HERE.

Be sure to complete all required fields; otherwise, application will not be sent!

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PRIMARY CONTACT INFORMATION

* Asterisk Thingy Denotes Required Field.

First Name:	*
Last Name:	*
Date of Birth:	* (eg. 05/21/1970)
E-Mail Address:	*

COMPANY PROFILE
Did You Know? There are no fees to have a Wholesale Account with DSDI™.

BILLING ADDRESS
Did You Know? E-Commerce Sales were $165.4 billion in 2010.

Street Address:	*
City:	*
State/Province *SPELL FULLY*:	*
Zip/Postal Code:	*
Country:	*

CONTACT INFORMATION

Telephone Number:	*
Fax Number:
Website Address:

REFERENCES ***required*** - click HELP if needed

First Business Reference:
Company:	*
Where Located:	*
Contact Person:	*
Telephone:	*
Email Address:	*
Second Business Reference:
Company:	*
Where Located:	*
Contact Person:	*
Telephone:	*
Email Address:	*

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DESIRED PASSWORD (used for account login)
Did You Know? It's against the law to pawn your dentures in Las Vegas!

Password:	*
Please confirm your password:	*

COMMENTS

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