New Dealer Form

    Date YYYY-MM-DD (required)

    Your Name (required)

    Business Name (required)

    Telephone Number (required)

    Your Email (required)

    Fax

    Business Street Address (required)

    City (required)

    State (required)

    Zip Code (required)

    Type of Business

    Business Classification

    Sole ProprietorshipPartnershipCorporation

    State of Corporation

    Subsidiary of (Name and Address)

    Business Type (Check all that Apply)

    Brick and Mortar Store - Please upload picture of store front with signCatalogOnline (Website)EBay Store (Username)Amazon Store (Store Name)Drop ShipRentalLaw EnforcementDefense InstructorFirst ResponseWholesale DistributorOther

    Ebay Store-username

    Amazon Store-Store Name

    What are the average sales per year in this category?(required)

    How did you hear about UDAP's products?(required)

    I hereby certify that I am authorized to enter into contracts for (subject) company.
    THIS INFORMATION IS COMPLETE AND ACCURATE TO THE BEST OF MY KNOWLEDGE. Name and Title (required)


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