Rfq_form Rfq Form
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Advanced Safety Devices 21430 Strathern St Unit M Canoga Park, CA 91304 Tel: 818.701.9200 Fax: 818.701.9220 REQUEST FOR WHOLESALES PRICING Date:_____________________________ RFQ #: _____________________________ Company Information Type of Sales Company Name: ____________________________________ □ Distributor ( ) □ Retail ( ) Federal Tax ID (EIN): _________________________________ □ Online Sale ( ) □ Filling a bid ( ) Buyers Name: ______________________________________ □ Armed Forces ( ) □ Procurement ( ) Street: ___________________________________________ □ Government ( ) □ Non Profit ( ) City: ______________________ State: ________________ □ OEM ( ) Zip Code: ___________ Method of Payment: DoD WAWF ( ) Phone #: ( Country:_____________________ ) _____________ Fax #: ( ) ___________ □ Term ( ) Email Address: ____________________________________ □ Credit Card ( ) Company Website: _________________________________ □ Wire Transfer ( ) Check One: □ C.O.D ( ) Corporation ( ) Sole Proprietor ( ) □ Products of Interest Product 1: Quantity:_____________ per Order ( ) Per Mounth ( ) Product 2: Quantity:_____________ per Order ( ) Per Mounth ( ) Product 3: Quantity:_____________ per Order ( ) Per Mounth ( ) Product 4: Quantity:_____________ per Order ( ) Per Mounth ( ) If open line of credit above $5,000.00 is desired, please include a copy of your credit references and your most recent financial statement. To eliminate delays in processing your request, please answer all questions asked. If you intend to resale online, you must provide us with your website address. SIGNATURE / _______________________/_______________/________________ (PRINT NAME) TITLE DATE PLEASE FAX THIS FORM TO: 818.701.9220 OR EMAIL TO: sales@safety-devices.com
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