App Dealer

SHS® International Dealer Application

* Indicates required field

Company Name *

Owner or Primary Contacts Name *

First

Last

Phone Number - Primary Contact *

Email - Primary Contact *

Billing Address *

Line 1

Line 2

City

State

Zip Code

Country

Shipping Address *

Line 1

Line 2

City

State

Zip Code

Country

Federal Tax ID# *

State Tax ID# (00 - if n/a for your state) *

Number Of Locations *

Date Established *

Company Type *

All Other Important Contact Information *

Short Description Of Business *

Do You Have A Website *

If Yes, What Is The Address? *

Authorized Dealer For: (Optional - Brands or Companies Products You Carry) *

Store Specialty *

Please Include The Following If You Wish To Purchase Via COD or Open Account Terms

Amount Of Credit Requested (In Dollars) *

Type Of Credit Requested *

Trade Reference 1:

Company Name *

Contact Name *

Company Fax *

Contact Phone Number *

Contact Email *

Current Terms With Company *

Trade Reference 2:

Company Name *

Contact Name *

Contact Email *

Company Fax *

Contact Phone Number *

Current Terms With Company *

Trade Reference 3:

Company Name *

Company Fax *

Contact Name *

Contact Phone Number *

Contact Email *

Current Terms With Company *

Acknowledgement & Authorization

Please review the terms & conditions for partnering with SHS® International, Inc. and working with SHS® International.

Click Here To Review Service Policies

1. I hereby certify that all answers given here in are true and complete to the best of my knowledge.
2. I give SHS International permission to contact the references here in.
3. I certify that I have read and agree to all terms and conditions in policies listed above.

I agree to all the above and submit this as my digital signature. *

Yes

Today's Date *

Submit