Retailer Registration Form

Business Name*

Legal Business Name (if different than above)

Company Tax ID (EIN)*

Principal Contact Name*

First Last

Title/Position*

Principal Contact Email*

Other Email Addresses (for account notices & communication)

Add additional email addresses for anyone who should receive information about pricing, promotions, account activity, etc.

Office Phone*

Sales Representative or Referred By*

Primary Retailer's Address

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Interested In Selling*

Primary Business*

Do You Sell Online?*

Websites you sell on*

Are you a member of a Buying Group?*

Buying Group*

Distributors You Purchase From*

Number of Store Locations*

Additional Store Name/Location #2

Additional Store #2 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Additional Store Name/Location #3

Additional Store #3 Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Do you have a Facebook page?*

Your Facebook Page

Like AquaFinesse on Facebook!

Retailer Acknowledgement*

Upon approval as an Authorized AquaFinesse Partner, I agree to abide by the terms & conditions of the Authorized AquaFinesse Reseller Agreement and MAP Policy.

Comments

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