Black Dog Machine, LLC
Dealer Application
Date
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Month
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Day
Year
Date
Company Name
*
Company Website
Name
*
First Name
Last Name
Phone Number
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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 Priority Mail
UPS
Fed-Ex
Best Way- Prepay & Bill
Pick Up
Shipping Account Number
Leave blank if you would like us to use our shipping account.
Payment
Once the order has been prepared for shipment, we will e-mail you a copy of the invoice that includes tracking. The e-mail will also include a payment link for you to pay the total due.
Company Credentials
Please provide one of the following credentials:
Seller's Permit #
FFL #
EIN
Please upload one of the above credentials
*
Browse Files
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Please list the products you are interested in purchasing.
Notes / Comments
Please note anything we should know or keep on file for you. This includes shipping instructions, special notes etc...
Electronic Signature
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Date
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Month
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Day
Year
Date
Please verify that you are human
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