Davitt & Hanser (D&H): Apply

Company Name:

Owner First Name:

Owner Last Name:

Date Established:

(mm-yyyy, example: 12-2015)

Federal Tax ID:

State Resale Number:

State Resale Number Expires:

(mm-yyyy, example: 12-2015; or mm-dd-yyyy, example: 12-31-2015)

Country of Operation:

Payment Method:

Company Type:

Description:

Required. Describe your company (for example, what kind of products do you sell?).

Does Your Company Have a Website:

If Yes, please enter your site's web address (URL):

Authorized Dealer For:

Which brands or suppliers? Please place each one on a new line.

Number of Locations:

How Did You Hear About Us?

Image Verification:

Apply: Step 1 of 5