Account Application "*" indicates required fieldsStep 1 of 425%Business InformationName of Business*Buyers*DBAFederal ID#*Sales Tax Exempt #Year Established*Number of Employees*Estimated Annual Sales*Phone*Email* Organization Type* Corporation LLC Partnership Sole ProprietorshipDescribe the type of Business along with primary goods and services offered*Other brands of hitches & towing products you currently sell*Contact InformationBilling Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Shipping same as Billing Address? Yes NoShipping Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Principal Name 1*Title*Home Phone*Email* Principal Name 2TitleHome PhoneEmail Accounting InformationAccounts Payable Contact*Title*Phone*Email* Has the firm or any of it’s principals ever filed Bankruptcy?* Yes NoIf yes, please explain*Credit InformationBusiness Trade ReferencesApply for Credit or Pay with Card per Order* Apply for Credit Pay per OrderCompany Name 1*Phone*Email* Company Name 2*Phone*Email* Company Name 3*Phone*Email* Attach additional page if necessary Drop files here or Select filesAccepted file types: doc, docx, pdf, Max. file size: 1 GB.Authorization of InvestigationI authorize investigation of all statements contained in this profile. I understand that misrepresentation of omission of facts called for, is cause for non-consideration for Dealer association or dismissal. I understand that this profile is not and is not intended to be a contractual agreement of any kind.Consent* If approved for credit I promise to pay all invoices within 30 days.Terms and Conditions*Review Pricing Policy I agree to the terms and conditions of the pricing policy.Name*Title*Δ
