Create a Dealer Application

Dealer Application
* Legal Business Name:
* Shipping Address:
 
* Shipping City:
* Shipping State:
* Shipping Zip:
* Phone:
* Your Email Address:
* Store Manager:
* Federal Tax ID:
* Yrs Current Owner:
* Accounts Payable Contact:
Accounts Payable Fax:
* Store Name:
* Mailing Address:
 
* Mailing City:
* Mailing State:
* Mailing Zip:
* Fax:
* Confirm Email Address:
Fishing Tackle Buyer:
* Yrs Business Est.:
* Business Type:
* Accounts Payable Phone:
* Accounts Payable Email:

 

Owner/Partners/Officers
* Name:
* Title:
* Home Phone:
* Driver's license #:
* Home Address:
 
* City:
* State:
* Zip:
Name:
Title:
Home Phone:
Driver's license #:
Home Address:
 
City:
State:
Zip Code:

 

Bank Reference
* Name:
* Address:
* City:
* State:
* Zip Code:
* Phone:
* Fax:
Contact:
* Business Checking Acct #:
Business Loan Acct #:

 

Established dealers with acceptable Trade References from sporting goods manufacturers/distributors are required to order a minimum of $750.00 for their opening order. New stores or dealers without acceptable Trade References from sporting goods manufacturers/distributors are required to place an opening order of $2,500.00 or more.

 

Trade References
(3 references required) First Trade Reference
*
* Name:
* Account #:
* Address:
* City:
* State:
* Zip Code:
* Phone:
Fax:

 

Second Trade Reference
*
* Name:
* Account #:
* Address:
* City:
* State:
* Zip Code:
* Phone:
Fax:

 

Third Trade Reference
*
* Name:
* Account #:
* Address:
* City:
* State:
* Zip Code:
* Phone:
Fax:

 

Payment Information
* Terms Requested:
* Anticipated Monthly $ Volume with Pitman Creek:
Total Annual Sales (All Products):
Total Annual Fishing Sales:
* Has this business or any of the principals ever been bankrupt?
If yes, please explain:


This form MUST be completed to process your application. This form MUST be completed if you are a new dealer, or if you want eCheck terms. Required for Kentucky dealers.


This application is intended for the sole purpose of Pitman Creek Wholesale extending open account status to its customers. This information is the property of Pitman Creek Wholesale and is not to be distributed to any parties outside of our Credit and/or Sales Departments.