+1.​​​443.790.2398

​​​​​​​​​​​​​​+1.410.768.2446

P.O. Box 836 Millersville MD 21108

​New Dealer Application

Please fill out this form completely. We will review your application and contact you shortly for verification.
This is not an application for credit. It is only an application to buy our products at discounted wholesale prices.
    

Company Name     
DBA (if used)   
Address 1   
Address 2   
City   
State   
Postal Code   
Country   
Phone   
Mobile   
Fax   
Website   
Email Address   
Contact First Name   
Contact Last Name   
Years in Business   
Primary Type of Business   
Federal Tax ID   
Sales Tax ID   
 
We will not be able to process your application without receiving a copy of Federal ID number,
State Sales Tax ID number, or a copy of a business license.
Please email a copy of your Federal ID and Sales Tax ID to duckbackcovers@aol.com