Dent Card/Smart Card – Dealership Order Form


Not a Registered Dealer



Dealer Information

Dealer Number    
Dealership Name    
Contact Person to receive Cards    
Contact Person Email Address    
Dealership Street Address    
Dealership City    
Dealership State/Province     
Dealership Zip/Postalcode    
Dealership Phone    
PO Number    

 

Card Order

All Packs Contain 50 Cards

90 Day Term Dent Card: # of Packs Requested       X  $350 per pack = $

180 Day Term Dent Card: # of Packs Requested     X  $500 per pack = $

90 Day Term Smart Card: # of Packs Requested     X  $500 per pack = $

180 Day Term Smart Card: # of Packs Requested   X  $750 per pack = $

Total*:    $                    


I agree with these Terms and Conditions.

                      

Special Branding setup and cost. Minimum quantity 250.

By Check

Mail Check , along with copy of order and/or PO# to:
Dent Wizard International Corporation
Attn: Evolution F&I Accounting
4710 Earth City Expressway
Bridgeton, MO 63044

By ACH

Vendor Name: Dent Wizard International Corporation
Vendor Address: 4710 Earth City Expressway
Receiving Bank Name & Address:
Enterprise Bank and Trust
3890 S Lindbergh Blvd
St. Louis, MO 63127
Routing #: 081006162
Account #: 402000072


*Payment must accompany this form to process the order