Dealer Application

Company Name *

DBA Name

Company Email *

Company Phone *

Company Fax

Market *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Billing Information

Is billing information the same as headquarters?

Billing Company Name

DBA Billing Company Name

Billing Company Email

Billing Company Phone

Billing Company Fax

Billing Address

Address Line 1

Address Line 2

City

State

Zip Code

Shipping Information

Is shipping information the same as headquarters?

Receiving Company Name

Receiving DBA Name

Receiving Company Email

Receiving Company Phone

Receiving Company Fax

Receiving Company Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Key Contacts

Owner's Name *

Owner's Email *

Sales Manager's Name *

Sales Manager's Email *

Purchasing Manager's Name *

Purchasing Manager's Email *

Accounts Payable

Account Payable Contact *

Account Payable Email *

Business Information

Website / URL *

Years in Business *

Do you own or lease? *

Business Entity Type *

Years at Present Location *

Average Monthly Sales *

Are you affiliated with a parent company, buying group or national account? *

Please Include the address

Industry wholesalers/manufacturers your currently buy from

Do you accept partial shipments? *

Should your order acknowledgement be sent by email or fax? *

Which email/fax account should order acknowledgements be sent to? *

Should your invoice be sent by email or fax? *

Which email/fax account should invoices be sent to? *

Sales Tax Information

Are you sales tax exempt? *

Upload tax exempt letter or resale certificate

Drag & Drop Files, Choose Files to Upload

Where are you located?

USA W9 Number

Canadian Business Number

European CHE Number

European EURI Number

Line of Business

Please mark the percent of business you do in each market

Office / Contract Dealer

Architectural / Acoustics Products Distributor

Educational Products Dealer

Online Reseller

Other

What furniture lines do you currently carry?

What acoustic product lines do you currently carry?

Upload showroom photos

Drag & Drop Files, Choose Files to Upload

Trade References

Reference #1 Company Name *

Reference #1 Contact Name *

Reference #1 Email Address *

Reference #1 Company Phone Number *

Reference #1 Company Fax Number

Reference #1 Company Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Reference #2 Company Name *

Reference #2 Contact Name *

Reference #2 Email Address *

Reference #2 Company Phone Number *

Reference #2 Company Fax Number

Reference #2 Company Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Bank References

Bank Name *

Bank Phone Number *

Bank Fax Number

Bank Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Product Catalogues

Which address do you want product brochures, price lists and literature sent to?

What product(s) are you interested in?

How did you hear about ezoBord?

Newsletter

ezoBord may keep me informed via email about products, services and events.

What would you like to hear more about through our newsletter?

Technical information (fire ratings, acoustical information, environmental, etc)
Installation information (install tips and tricks, case studies)
Inspiring design driven case studies (project features)

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Billing Information

Shipping Information

Key Contacts

Accounts Payable

Business Information

Sales Tax Information

Line of Business

Trade References

Bank References

Product Catalogues

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