Dealer Registration Form

Become an Authorized Dealer!
Please provide all required details below to qualify your business with us. If your company qualifies to become a dealer, a StopBox USA representative will be in contact with you to discuss further opportunities. Thank you for your interest in the StopBox USA Dealer Program.
Applicant Name*

First NameLast Name
Business Name*
Contact Number*

Area CodePhone Number
E-mail*
Company Website*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Store type*

Brick & MortarOnlineBoth
How many Sales Associates does your store employ?
Will you sell StopBox on Amazon?*

YesNo
Federal Tax ID - (EIN) Employer Identification Number*
Type of Business*
How long have you been in business?*
Please provide a short description about your company.*
Reseller Permit

Browse Files

Cancelof
How did you hear about us?*
If Other was selected above, please specify here:
After submitting the form, you will be redirected to create a dealer account.
Should be Empty:

Become an Authorized Dealer!