ATTENTION RETAILERS:
To apply for a dealership with our company please:
1. Fill out completely & submit the following form below.
2. Provide a copy of your business license / State certificate.
(by mail or fax) Fax: 937-376-8052
---OR---
1. Click here to download PDF version of this form and follow instructions.

* ALL FIELDS ARE REQUIRED TO BE FILLED OUT
This Application is for: (choose one)
  
Business Name:
 Date Business Started:
Name of Owners:
 Number of Locations:
Name of Contact Person:
 Store Hours:
Email Address:
 State Tax ID # :
  State License # :
Business Phone:
 Fax Number:
Bill to Information: Ship to Information:
Address Info: (street, city, state, zip, country)
 Address Info: (if different than billing)


Please choose yes or no in response to the following ...  
1. We have been a retail business for atleast 1 year
2. We keep regular store hours with sales clerks available at all times ...
3. Our business phone is answered in the business name ...
4. Our checking account is in the business name ...
5. We have a store front (subject to verification) ...
6. We have a product display area (subject to verification) ...
7. We are setup to ship UPS and other similar parcel services ...
8. We operate delivery trucks / trailers ...


INDUSTRY TRADE CREDIT REFERENCES  
Business Name:
 Business Phone:
Address:
 Fax Number:

   
Business Name:
 Business Phone:
Address:
 Fax Number:



















Save Edge | 360 West Church St. Xenia, Ohio 45385 | (937) 376-8268 | email us