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Contact Us
VALue Store
Avionics Products Distributor Application
Please provide the following
information for review
.
Should any item not apply, leave it blank.
Thank You
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
*
First
Last
Email
*
Phone Number
*
Financial Information
Annual Revenue
*
Payment Terms Requested
*
COD
Credit Card
NET 30
Estimated VAL Products Sales (Monthly)
*
*
Indicates required field
Person Completing Application
*
First
Last
Date submitted for Review
*
Title
*
Credit Application & References
(Required for Net 30 only)
Creditor (Vendor/Supplier/Company etc.)
*
Account Number
*
Contact
*
First
Last
Email
*
Phone Number
*
FAX Number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Creditor (Vendor/Supplier/Company etc.)
*
Contact
*
First
Last
Email
*
Account Number
*
Phone Number
*
FAX Number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Creditor (Vendor/Supplier/Company etc.)
*
Contact
*
First
Last
Email
*
Account Number
*
Phone Number
*
Phone Number
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Creditor (Vendor/Supplier/Company etc.)
*
Contact
*
First
Last
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Account Number
*
Phone Number
*
FAX Number
*
NET 30
payment term requests will require original signature/s on documents.
These documents will be sent to the applicant upon approval of and accepting their application.
If accepted as a
Net 30
customer, finance charges at a rate of
1.5%
per month on any delinquent balances will apply.
Submit