Become a Dealer

Line of Business
Year Established
Federal Tax ID
Type of Business
Upload Valid Reseller Permit
Max. file size: 8 MB.
Owner/Officer Name(s)
First Last Title
Owner/Officer Name(s)
First Last Title
Trade References(business name, phone & fax #’s, reference/account number)
Bank References (institution name, full address, phone number, account type, account number)
I certify that the information contained herein is correct and I authorize you to obtain such information as you may require concerning the statements made in this application, and agree that the application, including the information furnished by me, is true and complete and is made for the purpose of obtaining credit. I further agree to submit such additional information concerning my financial status as requested. I also understand that there is a 1.5% late charge per month on past due accounts. It is understood and agreed to that the undersigned will continue to be liable in the event of the sale of the business. I have read and agree to the terms of their application.
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4551 Lemar Road
Mercersburg, PA 17236

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Monday - Friday 7:30am-5pm
Saturdays 7:30am-2pm