Dealer Application

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Shipping Address

Mailing Address

Owner / Partners / Officers

Bank Reference

Trade Reference 1

Trade Reference 2

Trade Reference 3

Payment Information

Upload Store Photos


If you are able to upload the following files your application will progress more swiftly. If not, the photos may be emailed to info@pitmancreek.com and the forms may be faxed or emailed. f. 859-439-2060



Required Forms


Signatures MUST be hand-signed by the person who owns the bank account for the bank reference provided. Signatures completed digitally will not be accepted.

Consent Form PDF

Required for all applicants.
 


eCheck Form PDF

Required for new dealers.
 


KY State Cert PDF

Required for Kentucky Dealers