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

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

 



Consent Form PDF

Required for all applicants.
 


eCheck Form PDF

Required for new dealers.
 


KY State Cert PDF

Required for Kentucky Dealers