Distributor Referral Submission

 A Special Service for Suppliers

• Did you just receive a new order from a new or existing customer that needs to pay you up-front?
• Are any of your existing customers paying you excessively beyond terms and/or have bad credit?
• Are you paying credit card and other processing costs when distributors pay?

Promotional Capital will provide immediate payments to you for distributors that owe you money for their orders. And it costs you nothing!

Just refer your distributor-customer by submitting the information below and we will follow up immediately to set up your customer for our financing.

Required Fields*
YOUR INFORMATION
Your Name:*
Your Company Name:*
Your ASI #: (If a member)
Your PPAI #: (If a member)
Your UPIC #: (If a member)
Phone:*
Email:*
Company Address:*
City:*
State:*	Please Select Alaska Alabama Arkansas American Samoa Arizona California Colorado Connecticut District of Columbia Delaware Florida Federated States Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virgin Islands Vermont Virginia Washington Wisconsin West Virginia Wyoming Other...
Zip Code:*
DISTRIBUTOR REFERRAL
Primary Contact:*
Company:*
ASI #: (If available)
PPAI #: (If a available)
UPIC #: (If available)
Phone:*
Email:*
Company Address:*
City:*
State:*	Please Select Alaska Alabama Arkansas American Samoa Arizona California Colorado Connecticut District of Columbia Delaware Florida Federated States Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virgin Islands Vermont Virginia Washington Wisconsin West Virginia Wyoming Other...
Zip Code:*
Customer Order Number***
***PROVIDE YOUR P.O. NUMBER IF YOUR REFERRAL IS A RESULT OF A NEW ORDER JUST RECEIVED.
Questions/Comments:
	Please enter above security code:

THANK YOU. MAKE YOUR REFERRALS ANYTIME YOU ARE HAVING PAYMENT ISSUES WITH YOUR DISTRIBUTOR-CUSTOMERS.