The Georgia LX Club
New Vendor Online Application
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All Fields Are Required
Company Information
Your Full Name:
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GALXC Forums Username:
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Work Address:
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City:
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State:
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Zip:
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Full Time or "Day Job" Description:
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Home Phone Number:
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Work Phone Number:
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FAX Number:
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Primary Email Address
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(for all order information):
Other Email Address:
Website?
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Any Other Website?
Customer Reviews from other forums or websites(please supply links)
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If you are a new vendor or you have not conducted business on a forum before...Please provide
names and addresses of people who will vouch for your skills and reputation:
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Vendor Type:
Select the Vendor Type
Reseller
Merchandise
Fabricater
Tires/Wheels
Paint
Engine
Interior
Other
Brief description of goods/services (required):
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Please describe in detail if/why you qualify for AMM status instead of AV status
AMM = Authorized Member Merchant AV = Authorized Vendor:
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Fed Tax ID:
State Tax ID:
Sales Contact:
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Sales Contact Address:
Street:
City:
State:
Zip:
Sales Contact Email Address:
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Phone:
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Fax:
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Shipping Information
Logistics Contact:
Logistics Contact Email Address:
Phone:
Fax:
Vendor Comments
This section is for you to make any additional comments or requests
After Printing, Go to
Contract Page
.....Print, Sign and Date then include with this Document.
After Printing, Send Application via USPS To:
GALXClub.com
c/o Chuck Guldin
2254 Birchwood Drive
Columbus, Georgia 31909
Then Contact Forum Administrators via GALXClub.com Forum
Copyright © 2009 GALXClub.com
