Vendor Application Form

Thank you for taking the time to complete this form. We at RC Hill Mitsubishi, want to speak a with every vendor that is offering a service or product that helps or benefits RC Hill Mitsubishi and our Customers. In order for us to professionally manage our vendor relationships, we have established this form for us to better serve our vendors with respect and in a timely manner.

Please complete this simple from and explain what the services or product offered.

Thanks from the Management Team of RC Hill Mitsubishi, DeLand, Florida.

Company Name:

____________________________________________________________________

Address: ___________________________________________________________

City/State/Zip: _____________________________________________________

Phone: ______________________________ Fax:__________________________

Contact Name: _____________________________________________________

Contact Title: ______________________________________________________

Contact E-mail: ____________________________________________________

Contact Phone _____________________________________________________

Marketing E-mail ___________________________________________________

----------------------- COMPANY INFORMATION -----------------------

Organization Type: Sole Owner ___ Corporation ___ S-Corp. ___

State of Incorporation? ______________________ Nonprofit? ___Yes ___No

Other Socioeconomic Factor(s)?

___________________________________________

Domestic/Foreign Owned?

_______________________________________________

Is your company owned by a parent company? ___Yes ___No

Parent Company Name:

___________________________________________________________________

Parent Company Address:

___________________________________________________________________

Are you: Small Business? ___ Minority-Owned Business? ___ Veteran-Owned
Business? ___ Women-Owned Business? ___ Veteran Disabled-Owned Business? ___

Other Socioeconomic Factor(s)?

____________________________________________________________________

Does your company accept credit cards? ___Yes ___No

Explain what the services or product you offer:_________________________

_____________________________________________________________________

In What Way Can You Help Our Dealership:______________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Please FAX to (386)738-4370 Attention Accounting.