Check all that apply I have a designated place of business separate from a residence that is owned or leased.My business name matches the name I applied for under my Sales Tax Registration Number.My business uses phones, fax and an email address from a custom domain.I have at least three credit references to determine my financial fitness.My business has insurance on the place of business and on all inventories.My business is capable of ordering a minimum of $100,000.00 annually.My business is legally incorporated.My business sells related products such as garage service tools, equipment, etc.My business website provides information on products such as service tools, equipment, etc.My business is in good standing with BendPak, Inc.My business has public liability and property damage insurance, and I can submit a certificate of insurance in its name.
First Name
Last Name
Company
DBA
Address One
Address Two
City
State
Zip
Territory
Phone
Fax
Email
Website
Date Founded
Business License Number
Business License Number Issuing State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Annual Revenue
Employees
Industry
Type of Business Mobile Tool Dealer Auto Parts / Supplies Tire / Wheel Supplies Tool & Equipment Distributor E-Commerce Only
Business Locations 1 - 5 5 - 10 11 - 15 16 - 20 21+
Sold BendPak Previously Yes No
Sold BendPak Previously Explain
Annual Sales Volume $0 - $500,000 $500,000 - $1M $1M - $2M $2M - $5M $5M - $10M $11M - $25M $25M+
Annual Equip. Sales Volume $0 - $500,000 $500,000 - $1M $1M - $2M $2M - $5M $5M - $10M $11M - $25M $25M+
Sales Territory City County Regional State National
Comments