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Dealer Application Form
Thank you for your interest in establishing a customer account with Rollin Products. Please take a few minutes to complete the following information in its entirety and submit it to us. If you have any questions regarding this application, please call us at (800) 597-1195. Thank you.
Company Details
Legal Name of Firm*
DBA*
Primary Physical Address*
City*
State*
Zip*
Phone*
Fax
Mailing Address*
City*
State*
Zip*
Contact Person
Title*
Full Name*
Email Address*
Contact Number*
Alternate Contact Person
Title
Full Name
Email Address
Contact Number
Type of Business
Is Business Incorporated?*
Yes
No
Date Established
Annual Sales
Website (include http://)
Nature of Business
Wholesale
Retail/Dealer
Catalog
Internet
A and D
Are you an approved vendor and actively selling products on a GSA schedule?
Yes
No
Do you sell products on your website?
Yes
No
Do you have a showroom or retail store?
Yes
No
Do you have an outside sales force?
Yes
No
If so, how many?
Do you service Commercial or Educational market?
Commercial
Educational
If Educational, do you sell from a catalog?
Yes
No
What other brand lines do your carry?
How did you hear about Rollin Products?
Tradeshow
Brochure
Magazine Advertisment
Magazine Article
Email
Refereral
Current Customer
Consultant
Direct Mail
Other
Name*
Title*
Date*
Also send me a copy
Submit
* Required