To apply for a Milbank PowerGen - Wind dealership, please complete the following form. Required fields are marked with an asterisk (*).

 

1. Choose what type of dealership you are applying for...*

 

Choose what type of dealership you are applying for:

PowerGen Pro Wind Dealer (0-55kW), $7,500 Initiation Fee
PowerGen Wind Dealer (0-10kW), $5,000 Initiation Fee

 

 

2. Business information...

 

* Business Name

 

Parent Company

 

 

Billing Information...

 

* Address

 

Address (cont.)

 

* City

 

* State/Province

 

* ZIP/Postal

 

* County

 

* Phone

 

FAX

 

* Email

 

Web Site

 

 

Shipping Information...

 

* Address

 

Address (cont.)

 

* City

 

* State/Province

 

* ZIP/Postal

 

* County

 

 

* Owner

 

* Net Worth

 

* # of employees

 

* Year started

 

 

Please check the type of business...*

 

Type of Business Select... Sole Proprietor Partnership Limited Liability Company (LLC) C Corporation Sub-chapter S Corporation

 

 

Accounts Payable Information...*

 

* Contact

 

* Phone

 

FAX

 

Email

 

 

* D&B Rated?

 

* D&B Rated

Yes
No

 

If yes, D&B Acct

 

 

* Insurance coverage provided by...

 

* Insurance coverage provided by...

 

* Coverage Amount

 

* Insurance Exp. Date

 

 

3. Trade References...*

 

* Company Name

 

* Contact

 

* Address

 

* City

 

* State/Province

 

* ZIP/Postal

 

* Telephone

 

FAX

 

* Account

 

 

* Company Name

 

* Contact

 

* Address

 

* City

 

* State/Province

 

* ZIP/Postal

 

* Telephone

 

FAX

 

* Account

 

 

* Company Name

 

* Contact

 

* Address

 

* City

 

* State/Province

 

* ZIP/Postal

 

* Telephone

 

FAX

 

* Account

 

 

4. Bank Reference...*

 

* Bank Name and Branch

 

* Contact

 

* Telephone

 

* FAX

 

 

5. Sign...*

 

All questions on this application must be filled out in order to complete your account set up. Applications with blank information will be returned for completion.

 

I grant permission for Milbank or its agents to check our credit. I certify that I am authorized to sign this application on behalf of our organization and that the information given in this application is true and correct to the best of my knowledge.

 

I understand that there is a purchase requirement of a two turbine minimum, one of which will need to be installed and used as a display unit.

 

Signed (person filling out form)...

 

* First Name

 

* Last Name

 

* Title

 

* Email

 

* Date

 

Note: You must fill out Tax Form 149 (resale tax status) on the next page.

 

 

6. Comments...

 

Comments

 

7. Please retype the words you see below...*