Dealer Application Dealer Application Dealer Application Company First Name (Main Contact) Last Name (Main Contact) Phone (Main Contact) Email (Main Contact) Company Name Date Website/URL Address City State Zip Additional Contacts Sales First Name (Sales) Last Name (Sales) Phone (Sales) Email (Sales) Accounting First Name (Accounting) Last Name (Accounting) Phone (Accounting) Email (Accounting) Business Information Years In Business Business Type IncorporatedPartnershipProprietorshipOther Business Type Fed Tax ID# Market(s) you currently represent Marine Utility PWC Your Geographic boundaries or territories for sales &/or service? List Brands and other Product lines you carry How did you hear about us Signature Clear Attach Your Tax Exempt Certificate Drop a file here or click to upload Choose File Maximum file size: 268.44MB Office Use Only By Signing Your Name, You Hereby Say That the Above Information is true. If you are human, leave this field blank. Submit