Dealer Application

Dealer Application Form
Are you a luthier? Complete a luthier application instead to access luthier-level pricing.

Luthier Application
Business Information
Name of Business*
Business Website
Date Business Started*

MonthDay Year
Business GST/HST #
Business Phone Number*
Please enter a valid phone number.
Business Email*
Please enter a valid email address.
Address of Business*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Owner Information
Name of Business Owner*

First Name Last Name
Is the business address is the same as owner's home address?*

YesNo
Address of Owner*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Trade References
1. Name of Company
Phone Number
Please enter a valid phone number.
2. Name of Company
Phone Number
Please enter a valid phone number.
3. Name of Company
Phone Number
Please enter a valid phone number.
Acceptance

The applicant agrees that the Credit Terms granted by Counterpoint Musical Services are that all accounts are due and payable within 30 days from the date of invoice unless otherwise stipulated in writing and that a service charge will be paid by the customer on all amounts beyond these terms.
Signature of Applicant*

Clear
Date*

MonthDay Year
Date
Should be Empty:

Dealer Application Form