Black Dog Machine, LLC
Dealer Application
Date
*
-
Month
-
Day
Year
Date
Company Name
*
Company Website
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Billing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Shipping Address (If different from billing)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred Shipping Method
*
USPS
UPS
FED-EX
BEST WAY/PREPAY & BILL
PICK UP
Shipping Account Number
If Applicable
Payment Information
Invoice will be e-mailed as soon as shipment is ready with a link to pay for your order.
Please list the products you are interested in purchasing
Company Credentials
Please provide one of the following credentials:
Seller's Permit #
Sales tax will be applied to your order if no seller permit entered & uploaded.
FFL #
EIN
Please upload one of the above credentials
*
Browse Files
Cancel
of
Notes / Comments
Please note anything we should know or keep on file for you. This includes shipping instructions, special notes etc...
Electronic Signature
*
Clear
Date
*
-
Month
-
Day
Year
Date
Please verify that you are human
*
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