Wholesale Dealer Account Application
To become an authorized Yukon Outfitters dealer, we require an operational storefront, along with a wholesale tax ID# and permit. We are currently not accepting “online only” customers.
General Company + Business Overview
Company Name
*
Company Website
How long have you been in business?
*
How did you hear about Yukon Outfitters?
*
If your answer is Yukon Sales Representative, please enter their name above
Where will you sell Yukon Outfitters products?
*
Please Select
Retail Store
Retail Store and Online
Online Only
Corporate Promotion
Please select all that describe your business:
*
Convenient Store
Corporate Gifts
Gift + Boutique
Government Agency
Hardware Store
Hook & Bullet
Online Retailer
Outdoor Specialty
Sporting Goods
State / National Park
Other
Products of Interest (Check all that apply)
Bags + Storage
Drinkware
Hammocks + Accessories
Hard + Soft Coolers
Hunt + Fish
Made in USA
All Yukon Products
What other brands do you currently carry?
Contact, Shipping and Billing Info
Main Point of Contact (Name)
*
First Name
Last Name
Main Point of Contact (Email)
*
email address of contact for discussing order related matters
Business Phone Number
*
Cell Number
Is your shipping location classified as business or residential?
*
Business
Residential
Shipping Address (product will be delivered to this store or warehouse address)
*
Street Address
Street Address Line 2
City
Please Select
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
State
Zip Code
Shipping Services (check all that apply)
Lift gate required to unload palletized goods.
Delivery appointment required.
Billing Address (mailing invoices and other periodic communications)
*
Street Address
Street Address Line 2
City
Please Select
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
State
Zip Code
Billing Email
*
email address to send invoices
Preferred Payment Method
ACH
Credit Card
Check
Wire Transfer
Dead Presidents
Tax Exempt Status
Please provide supporting details, if your organization qualifies for tax exempt status.
Reason for Tax Exempt
Please Select
Government Entity
Charitable Organization
Religious Organization
Educational Organizaton
Resale
Tax Exempt ID Number
File Upload
Browse Files
Drag and drop files here
Choose a file
If you prefer, upload you state resale certificate here.
Cancel
of
Credit Card Payment Authorization
Check Box to Confirm
*
I hereby authorize MOAM Group, Inc. (dba Yukon Outfitters) to charge the credit card on file for the full value of product shipped. If your account is approved, you will be sent a secure link to provide your credit card information. You will not be asked to provide Credit Card information as part of the application process.
Dealer Agreement + MAP Policy
Sign and Submit
This form must be completed and signed by an authorized company representative.
Name
*
First Name
Last Name
Job Title
*
Signature - I hereby certify that the above information is true and correct to the best of my knowledge and ability.
*
Submit
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