Thank you for taking the time to complete this form.  We at RC Hill Mitsubishi, want to speak a with every vendor that is offering a service or product that helps or benefits RC Hill Mitsubishi and our Customers. In order for us to professionally manage our vendor relationships, we have established this form for us to better serve our vendors with respect and in a timely manner.

Please complete this simple from and explain what the services or product offered.

Thanks from the Management Team of RC Hill Mitsubishi, DeLand, Florida.

 Company Name:

____________________________________________________________________ 

 Address: ___________________________________________________________

 City/State/Zip: _____________________________________________________

 Phone: ______________________________ Fax:__________________________

 Contact Name: _____________________________________________________  

 Contact Title: ______________________________________________________

 Contact E-mail: ____________________________________________________   

 Contact Phone _____________________________________________________
  
 Marketing E-mail ___________________________________________________

  
 ----------------------- COMPANY INFORMATION -----------------------


 Organization Type:     Sole Owner ___ Corporation ___  S-Corp. ___

 State of Incorporation? ______________________  Nonprofit? ___Yes     ___No
 
Other Socioeconomic Factor(s)?

___________________________________________

 Domestic/Foreign Owned?

_______________________________________________

 Is your company owned by a parent company? ___Yes     ___No
 
Parent Company Name:

___________________________________________________________________

 Parent Company Address:
___________________________________________________________________
 
 Are you:  Small Business? ___  Minority-Owned Business? ___  Veteran-Owned
 Business? ___  Women-Owned Business? ___  Veteran Disabled-Owned Business? ___
 
Other Socioeconomic Factor(s)?

____________________________________________________________________
 
 Does your company accept credit cards?  ___Yes     ___No

 Explain what the services or product you offer:_________________________

_____________________________________________________________________


   
 In What Way Can You Help Our Dealership:______________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Please FAX to (386)738-4370 Attention Accounting.