DEALER REGISTRATION FORM
Please review the form and have all required information (*) available before you begin.
DEALER NAME
*
Full legal name
Dealer Alignment (old freetext field)
*
Dealer Alignment
Please Select
Allsteel
Haworth
MillerKnoll
Steelcase
Teknion
Unaligned with any of the above
Primary Contact Name
*
Primary Phone #
*
###-###-####
Primary Email
*
example@example.com
Sales Contact Name
Sales Phone #
###-###-####
Sales Email
example@example.com
Accounting Contact Name
*
Accounting Phone #
*
###-###-####
Accounting Email
*
example@example.com
Orders Contact Name
Orders Phone #
###-###-####
Orders Email
example@example.com
Invoice / Bill To Address
*
Use 2-letter State abbreviation. Don't spell state name.
Is this the DEFAULT shipping address?
YES
Ship To Address (leave blank if it varies by P.O.)
DISCOUNT (standard)
*
55 LANDED
55 WILL CALL
56 LANDED
56 WILL CALL
57.5 LANDED
57.5 WILL CALL
60 LANDED
60 WILL CALL
Other- see Comments
DM Account Manager
*
Joanna
Maria
Pablo
Tiffany
SPIFF Eligible?
*
Yes
No
REP FIRM
*
Individual Rep at Rep Firm (name)
*
Additional Comments / Special Instructions
* Prior to our ability to run a credit check, initial payment terms is full Payment Before Shipment (PBS). When sales volume exceeds $10,000 per year, credit terms may then be extended upon request and satisfactory qualification based on DUNS report and trade references. In any case, an order exceeding $10,000 net requires a 50% deposit with P.O. tender, with balance of payment due before Ship Date.
750 characters limit
Submitted by (name):
*
My Email is:
*
example@example.com
Submit
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