New Dealers Form

All fields with an * are required.

Company Info

Company Name*

Enter your company name.

Address*

Enter your company address.

City*

Enter your company city.

State*

Enter your company state.

ZIP Code*

Enter your company ZIP code.

Billing Address

Different than address listed above. Invalid Input

Billing Address*

Enter your company billing address.

Billing City*

Enter your company billing city.

Billing State

Enter your company billing state.

Billing Zip Code

Enter your company billing ZIP code.

Phone*

Enter the main company phone number.

FAX

Enter your company FAX number.

Website Address*

Enter your company website address. Include http://

Include http:// in your URL.

Upload Logo

Check that your file size is not greater than 30KB and your format is jpg or png.

Make sure company name is clearly visible in file name. Can't be taller than 80 pixels or wider than 80 pixels. File size no larger than 30KB. Must be a jpg or png format.

Sales Tax ID Number*

Enter your company Sales Tax ID Number.

Contact Info

Primary Contact Name*

Enter the first and last name of your company's primary contact.

Primary Contact Phone*

Enter the phone number (and extension) of your company's primary contact.

Include extension if applicable.

Primary Contact Cell

Enter the cell phone number of your company's primary contact.

Primary Email*

Enter the email address for your company's primary contact.

Accounts Payable

Different than primary contact listed above. Invalid Input

Accounts Payable Contact Name*

Enter the name of your company's accounts payable contact.

Accounts Payable Phone*

Enter the phone number (include extension) of your company's accounts payable contact.

Include phone extension if applicable.

Accounts Payable Cell

Enter the cell phone number of your company's accounts payable contact.

Accounts Payable Email*

Enter the email address of your company's accounts payable contact.

May we email invoices?*

YesNo

Select if invoices can be emailed or not.

Note or Comment

Enter a note or comment.

Prove It!*

Invalid Input

Notice: Sales Territories and Authorized dealers are determined exclusively by Franks Manufacturing. Franks Manufacturing reserves the right to determine dealership status at any time.

The Blynd - New Dealer Info

Company Info

Contact Info