Wholesale/Sales Agent Sign-up Form

Please complete the form below and our sales manager will contact you regarding distribution or sales agent opportunities.

Section One

Company Name:
Primary Contact:    Title:
Telephone #:    Extension:
Billing Address:
City:    State/Province:
Country:    Zip Code:
Business Website URL:
Type of Business:
Sales Agent Importer Distributor
Retailer Drop Ship End User (Government Agencies, Schools, Non-Profit Organizations)

Section Two

Business Registration:
S or C Corporation Limited Liability Corp Partnership Sole Proprietorship
Tax Identification #:
Years in Business:
Business Territory:

Section Three

Product Lines Distributed:
Sales Channels:
Automotive Aviation Camping/Hiking Corporate Gifts
Education Emergency Preparedness Environmental Hardware/Electrical
Gov/Military Marine Non Profit Product Reviews

Section Four

Representatives Name:
Title:
Email Address:


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