Call Us:(352) 799-4139
FAX LINE: (352) 799-4647

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4012 Benchmark Trail, Brooksville, FL 34604

Our Web Site Address: slotcarsusa.com

Office & Tech (352) 799-4139

Our online store: crawleydistributinginc.com

Toll Free Order Line (888) SLOTCAR

Online orders at: Orders@slotcarsusa.com

24 Hour Fax Line (352) 799-4647

For Info Contact: Tech@slotcarsusa.com

Dealer Information

Thank you for your interest in Crawley Distributing Inc. Before we can process your account we require the following information.

  • Date: Date Business was Established: Phone Number:
  • Business Name (DBA): Fax Number:
  • Business Address: E-Mail Address:
  • City or Town: State: Zip Code:
  • Shipping Address(If different from Business address):
  • City or Town: State: Zip Code:
  • Business License Number (Tax Id.):
  • State I.D. Number: Federal Employer I.D. Number:

Type of Business (Please Check One):

Name and Addresses of Principals

  • Name: Title:
  • Home Address: Mobile Number:
  • City: State: Zip Code: Home Phone:
  • Name: Title:
  • Home Address: Mobile Number:
  • City: State: Zip Code: Home Phone:
  • Name: Title:
  • Home Address: Mobile Number:
  • City: State: Zip Code: Home Phone:

In order to substantiate your account as soon as possible, we will need trade references (Distributors and/or manufactures in the slot car racing industry only).

  • Name: Phone:
  • Address:
  • City: State:Zip Code:
  • Type of Account (Check One):
  • Name: Phone:
  • Address:
  • City: State:Zip Code:
  • Type of Account (Check One):
  • Name: Phone:
  • Address:
  • City: State:Zip Code:
  • Type of Account (Check One):

For Corporations Only

I hereby guarantee any indebtedness to " Crawley Distributing Inc." incurred by:

  • Corporation Name:
  • Individual Guarantor/Owner:
  • Individual Guarantor/Owner:

The Corporate Application section must be signed by the owners as personal guarantors of all purchases made by the corporation in order to receive a positive review. This section does not have to be signed if you wish to only be on a CREDIT CARD basis.

Please

Affix

Corporate

Seal

Here

  • Bank Information (All Accounts)


    Name of Bank: Account Number:
  • Address: Date Account Established:
  • City: State: Zip Code: Home Phone:

Credit/Debit Card Information

Please do not fill out this information until requested to do so after your account has been approved

Type of card (Please Check One):

Title of card (Name of holder):

Card number: Expiration date: Security code:

  • City: State:Zip Code:
  • PayPal:

Please list any and all personal that are authorized to call and/or order for this establishment

1: 3:

2: 4:

Although we do not require the following information we ask you fill so we can use it for customer referral purposes.

Style of Track(s)

Overall Length

Manufacturer

  • 1:
  • 2:
  • 3:
    • Store Hours
      • Monday::
      • Wednesday:
      • Friday:
      • Sunday:
      • Tuesday:
      • Thursday:
      • Saturday:

2014