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Ross Molds

Dealership  Application

Initial order must accompany Application

Date:_________                                                                                       Invoice___________

Dear Customer, 

Thank you for your $500  purchase.

You will receive a 40% discount on all  $100 retail purchases. ($60 Net) for this year.

            Two purchases per year are required.

            This will entitle you to receive 40%  for the next year.

If you would like to become a RiverView Dealer, we need the following information:

1.         Name of business: __________________________________________ 

2.         Personal name: _____________________________________________
           

3.         Address: __________________________________________________

4.        City, State & Zip:____________________________________________      

5.        Phone: _____________________________________________________

            6.        Fax:_______________________________________________________
           

7.        Email: _____________________________________________________

            8.        Tax No. ____________________________________________________

RiverView Molds, Inc.
2141 P Avenue Williamsburg, Iowa 52361
1-319-668-9800  Phone     1-319-668-9600  Fax
http://www.riverviewmolds.com/ Email: rivervie@avalon.net

02/26/2007