Phyzex Technologies Inc. works through our worldwide network of dealers and distributors. Please read our Top 6 Reasons to become a Progryp Gym Gear dealer. If you are interested in joining our team follow the directions below:

Please brief us on your company by filling out the boxes below. If you have a retail store, please indicate its location.

Customer Information:

First Name:
Last Name:
Company:
Postal Address:
Street Address:
City:
State, Province:
Postal or Zip Code/Country:
Telephone:
Fax:
E-Mail:
Website:
Industry:
Position:
(If applicable)
A Brief History of Your Company:



Credit Application:

 

NEW ACCOUNT INFORMATION & CREDIT REFERENCES

Name:
Address:
Phone #:  
Fax #:
If account payable address different from above please indicate:
Name of contact - Accounts Payable:
Position - Title:
Owners/Directors - Name/Title:
Bank Name:
Bank Address:
Account Number:
Number of years in Business:
GST Registration #:
If Prov. Sales exempt, please state Lic. #:

 

Credit References:

Name:
Address:
Phone #:

Fax #:



 
Name:
Address:
Phone #:

Fax #:



 
Name:
Address:
Phone #:

Fax #:

 


 

 


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