MNP QR Code 

Dealers:

    Please print out and fax back to MNP (804-447-3195)

Any Questions Feel free to call or e-mail. ([email protected])

Thanks for your interests in our products.

MNP LLC
Many New Products
P.O. Box 9593
Henrico, VA 23228
1-804-447-3195 ph/fx

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Dealer Information Form:

Trade Name of Firm _________________________________________________________________________

Name of Owner (s) ______________________________________ Contact Name________________________

Business Address ___________________________________________________________________________

City _______________________________ State ______________________Zip Code ____________________

Telephone Number __________________________ Retail Sales Number ______________________________

Fax Number ________________________________ Year Business Established _________________________

Web address________________________________ E-Mail address_____________________________________

Approx. Annual Sales Volume___________________ No. of Employees_________ No. of salesmen________

Method (s) of Sale: Retail Store_________ Catalog _________(Please send copy for our file)

Principal Lines Sold and stocked________________________________________________________________

_____________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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Trade References ( Please do not include Banks, Visa, or MasterCard as references)

Company Name _____________________________________ 

Address ___________________________________________ 

City ___________________ State ______ Zip Code_________ 

Phone # __________________ Fax #_____________________ 

Web address____________________E-Mail address_________________

Your Name__________________________________ Title ____________________

Signature ___________________________________ Date __________________

Company Name _____________________________________

Address ___________________________________________

City ___________________ State ______ Zip Code_________

Phone # __________________ Fax #_____________________

Web address_______________ E-Mail address________________

Your Name__________________________________ Title ____________________

Signature ___________________________________ Date __________________

Company Name _____________________________________

Address ___________________________________________

City ___________________ State ______ Zip Code_________

Phone # __________________ Fax #_____________________

Web address__________________E-Mail address___________________________

Your Name__________________________________ Title ____________________

Signature ___________________________________ Date ___________________

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Last modified: October 10, 2023