Interested in working together? Please complete the New Dealer Credit Application below: Business Name * First Name Last Name Business Mailing Address for Orders * Business Billing Address (if different) Contact for Ordering * First Name Last Name Contact Email * Contact Phone Number * (###) ### #### Contact for Accounts Payable * First Name Last Name Accounts Payable Email * Accounts Payable Phone Number * (###) ### #### Company is Registered as? * Corporation LLC Sole Proprietor Partnership Other Corporate Registration Number * Federal ID # * Number of Years in Business * Trade Reference #1 * Provide Business Name, Contact Name, Phone Number and Email Address Trade Reference #2 * Provide Business Name, Contact Name, Phone Number and Email Address Trade Reference #3 * Provide Business Name, Contact Name, Phone Number and Email Address How did you hear about Rusteprufe®? Website Tradeshow Word of mouth Other Acknowledgement * By checking the box below applicant attests financial responsibility ability and willingness to pay our invoices in accordance with our terms. The information on this form is for the purpose of obtaining credit and is warranted to be true. Agree Disagree Message Thank you for your interest in becoming a Rusteprufe® Dealer!We will review your submission and get back to you as soon as possible.
