AutomotiveCatalog2024

Schiffer Publishing 4880 Lower Valley Rd. Atglen, PA 19310 610.593.1777 [email protected] Revised June 2021 Company Name: Address: City: State: Zip Code: Contact Name: Telephone: Account #: Fax: Company Name: Address: City: State: Zip Code: Contact Name: Telephone: Account #: Fax: By signing below, I certify that all information is correct to the best of my knowledge. You are authorized to contact the references provided. You are authorized to send me printed and/or emailed information about your company. Name: ________________________________________ Title: ________________________________________ Signature: ____________________________________________________ Date: _________________________ FOR OFFICE USE ONLY: Sales Rep Sales Channel K C or I Geographic Code Backorders Y/N Catalogs Payment Terms Discount Shipping Method Returnable Y/N Additional Notes: