Dealer Application Form

If you are interested in buying DMT® products for resale

Please fill out the following fields if you would like to begin the process of becoming a dealer for DMT® products. Please fill out ALL FIELDS as we cannot process your request without the information. Thank you for inquiring about DMT®!!

*indicates required field

Wholesaler / Dealer Company Profile:

COMPANY NAME:*
STREET ADDRESS:
CITY:* STATE:* ZIP:*
COUNTRY:

MAILING ADDRESS:
CITY: STATE: ZIP
COUNTRY:

PHONE NUMBER: FAX NUMBER:
PRIMARY CONTACT PERSON: TITLE:
EMAIL ADDRESS:*

SELECT:
   Corporation* Partnership Sole Proprietorship
  *If Corporation:    State Incorporated In:    Date of Incorporation:
Do You Have a Federal Tax Identification Number? YES NO
Federal Tax Identification Number   

HOW MANY YEARS HAS THE COMPANY BEEN IN BUSINESS?
YEARS AT PRESENT LOCATION?

WHAT TYPE OF BUSINESS ARE YOU IN (enter percent if more than one):
CUTLERY % GOURMET %
NURSERY/GARDEN % HARDWARE %
WOOD % SPORTS %
RESTAURANT SUPPLY % INDUSTRIAL %

YOU ARE PURCHASING FOR:
RESALE USE IN YOUR BUSINESS

KEY PERSONNEL
NAME TITLE

YOUR WEBSITE ADDRESS:
DO YOU HAVE A CATALOG? YES NO
If Yes, Frequency?
HOW MANY SKU's DO YOU SELL?
DO YOU CURRENTLY CARRY DMT® PRODUCTS? YES NO
If so, where do you purchase them? (Please list all sources)

DO YOU HAVE ADDITIONAL OFFICE LOCATIONS?
YES NO
If Yes, Please List: PRIMARY CONTACT, ADDRESS, PHONE, & FAX for each:

DO YOU HAVE WAREHOUSE FACILITIES?
YES NO
   If Yes, Please Describe (please include square footage):

DO YOU HANDLE PRODUCTS THAT ARE COMPETITIVE WITH DMT® PRODUCTS?
YES NO
If Yes, Please Explain:

ARE YOU PART OF A BUYING GROUP / AFFILIATION / COOP?
YES NO
If Yes, Please List:

DO YOU MANUFACTURE PRODUCTS?
YES NO
If Yes, Please Describe:

LIST THE COMPANIES / MANUFACTURERS THAT REPRESENT THE MAJORITY OF YOUR SALES VOLUME.
Please indlude: COMPANY NAME, PRODUCT(s), & IF YOU CARRY STOCK

WHICH COMPANY REPRESENTS THE LARGEST PERCENTAGE OF YOUR SALES VOLUME?



INFORMATION FOR THIS FORM WAS AUTHORIZED BY:
NAME:*
TITLE:*
DATE:*

The following fields are required: