Yukon Outfitters - Wholesale Account Application

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 all that describe your business:*

Convenient StoreCorporate GiftsGift + BoutiqueGovernment AgencyHardware StoreHook & BulletOnline RetailerOutdoor SpecialtySporting GoodsState / National ParkOther
Products of Interest (Check all that apply)

Bags + StorageDrinkwareHammocks + AccessoriesHard + Soft CoolersHunt + FishMade in USAAll Yukon Products
What other brands do you currently carry?
Contact, Shipping and Billing Info
Main Point of Contact (Name)*

First NameLast 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?*

BusinessResidential
Shipping Address (product will be delivered to this store or warehouse address)*

Street Address

Street Address Line 2

CityState/Province

Postal/Zip CodeCountry
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

CityState/Province

Postal/Zip CodeCountry
Billing Email *
email address to send invoices
Preferred Payment Method

ACHCredit CardCheckWire TransferDead Presidents
Tax Exempt Status

Please provide supporting details, if your organization qualifies for tax exempt status.
Reason for Tax Exempt
Tax Exempt ID Number
File Upload

If you prefer, upload you state resale certificate here.
Cancelof
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

By signing this agreement you accept the terms and conditions of the Yukon Outfitters Dealer Agreement and MAP Policy attached.
Sign and Submit

This form must be completed and signed by an authorized company representative.
Name*

First NameLast Name
Job Title*
Signature - I hereby certify that the above information is true and correct to the best of my knowledge and ability.*

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Wholesale Dealer Account Application

General Company + Business Overview

Contact, Shipping and Billing Info

Tax Exempt Status

Credit Card Payment Authorization

Dealer Agreement + MAP Policy

Sign and Submit