Dealer Application

NEW DEALER APPLICATION
Thank you for your interest in becoming a Kroll Dealer!

Please complete the online application—once submitted, a Dealer Success Team Member will reach out to verify your information and request any additional details needed to set up your account.

Questions? Contact us at dealersuccess@krollcorp.com or call 800-359-6912. We look forward to working with you!
Were you referred by a Manufacturer or Manufacturer Sales Rep?
Please enter the name of the Manufacturer or Brand that referred you:
How did you hear about us?
Please enter the name of the Trade Show/Event:
Please enter the name of the person or company that referred you:
Please enter the name of the website or social media platform you found us on

CONTACT INFORMATION
Business / Company Name
Contact Name

First NameLast Name
Title
Business Email Address
example@example.com
Phone Number (Business)
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number (Home)
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number (Mobile)
Please enter a valid phone number.Format: (000) 000-0000.
Fax Number
Please enter a valid phone number.Format: (000) 000-0000.

FINAL STEP: CONFIRM & SIGN
Let’s get you set up—fast and with confidence
To start our partnership on the right foot, please review and confirm the basics below. Checking the boxes helps us activate your account quickly and keep orders moving smoothly.
Let’s get you set up—fast and with confidence
To start our partnership on the right foot, please review and confirm the basics below. Checking the boxes helps us activate your account quickly and keep orders moving smoothly.
Name

First NameLast Name
Company Name
Email
example@example.com
By signing below, I confirm that I understand this agreement and consent to use an electronic signature in lieu of a physical signature. I acknowledge that my electronic signature has the same legal standing as my handwritten signature.
Should be Empty:

NEW DEALER APPLICATION