Dealer Application

If you are interested in buying Belltone Leather items for resale, please fill out the following fields if you would like to begin the process of becoming a dealer for Belltone products. Please fill out ALL REQUIRED FIELDS as we cannot process your request without the information. Thank you for inquiring.

Your Name (required)

Your Email (required)

Company Name (required)

Street Address (required)

City (required)

State (required)

ZIP (required)

Country (required)


Mailing Address

Mailing Address City

Mailing Address State

Mailing Address ZIP

Mailing Address Country


Phone

Fax

Contact Person

Contact Title

Contact Email Address


Company Type
CorporationPartnershipSole Proprietorship

*If Corporation:
State Incorporated In:

*If Corporation:
Date of Incorporation:

Do You Have a Federal Tax Identification Number or Sellers Number?
YesNo

If yes, your Federal Tax Identification Number will be required with application approval.


How Many Years Has The Company Been In Business?

Years at Present Location?


You Are Purchasing For:
ResalePrivate-Label Program


Key Personnel (Name/Title):


Your Website Address:

Do You Have a Catalog?
YesNo

If Yes, Frequency?

Do You Currently Carry Leather Care Products?
YesNo

If so, where do you purchase them? (Please list all sources)

Do You Have Additional Office Locations?
YesNo

If Yes, Please List: Primary Contact, Address, Phone, & Fax For Each:

Do You Have Warehouse Facilities Where to Ship Orders?
YesNo


Information For This Form Was Authorized By (Name/Title/Date):


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