VersiGrid
PO Box 838
Milltown, Montana 59851

Business Phone: (425) 657-7958
Email: office@versigrid.biz
DATE:___________________
Mail to:
VersiGrid,  ATTN: Dealer Applications
            PO Box 838
Milltown, Montana 59851

Website: versigrid.com
Please complete the Dealer Application form, then Print this page and FAX or mail it to VersiGrid.
Your Name:
Your complete Email address (e.g. "me@work.com"):
The name of your business:
Your type of Business:
Gross Annual Sales:
What is your main source of revenue, sales or customers?
Details or comments:
Are you able to maintain an inventory?:
Details or comments:
Do you have a showroom or retail store?
Yes, a business showroom.
Yes, a walk-in retail store.
No, not at this time.
I will display the products used at my ranch or farm.
Detail or comments:
Address Line 1:
Address Line 2 (if necessary):
City:
State:
Zip Code:
Phone Number:
Mobile or Cellular Phone (if applicable):
What is the best time for us to call you (and Time Zone)?
Fax Number if available:
Include as many comments as you like, or email them to "office@versigrid.biz.com":