Dealer Application Dealer Application Dealer InformationLegal Business Name*DBA/Shop Name*Years in BusinessLegal Entity* Individual/Sole Proprietor Partnership Corporation Year EstablishedDo you sell on the internet* Yes No Via Mail Order?* Yes No Billing and Shipping InformationBilling Address (Address, City, State, Zip)*Shipping Address (Address, City, State, Zip)Contact InformationShop Owner*Shop Owner Email*Shop Owner Phone Number*Shop Buyer*Shop Buyer Email*Shop Buyer Phone Number*Accounts Payable Contact Name*Accounts Payable Email*Accounts Payable Phone Number*Shop WebsiteTerms and ConditionsIf your check is returned by the bank as NSF or uncollectible, a $30 service charge will be added to your account. Krueger Outdoor, SBC reserves the right to change your account terms at any time without any prior notification. Krueger Outdoor, SBC reserves the right to close an account for any reason, including failure to provide true and accurate information on this application, and MAP violation.* I have read the above terms and conditions and warrant that the foregoing information is true and correct. Name*Date*Comments