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VALue Store
Avionics Products Distributor Application
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General Information
Company Name
*
Year Business Opened
*
Total Number of Employees
*
Physical Address
*
Line 1
Line 2
City
State
Zip Code
Country
Phone Number
*
FAX Number
*
Web Address
*
Airport Name
*
Billing Address if different than physical address
*
Line 1
Line 2
City
State
Zip Code
Country
Email Address
*
Airport Identifier
*
Shop Labor Rate (Technical)
*
Shop Labor Rate (Installation)
*
Number of Installers
*
FAA Air Agency Certificate Number
*
Repair Station Ratings
*
Business Activities (Choose All that apply)
*
Avionics Installations
Avionics Repair
OEM
Airline
Military/Government
FBO
Piston
Turbine
Helicopter
Homebuilt
Staff Contact Information
Company CEO/Owner
*
First
Last
Email
*
Phone Number
*
Avionics Sales/Service/Installation
*
First
Last
Email
*
Phone Number
*
Purchasing
*
First
Last
Email
*
Phone Number
*
Accounting
*
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Last
Email
*
Phone Number
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Financial Information
Annual Revenue
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Payment Terms Requested
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COD
Credit Card
Estimated VAL Products Sales (Monthly)
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Person Completing Application
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Last
Title
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