Confidential Dealer Application

By completing this form, you are applying for Dealer status with Transland. All information will be held in strict confidence.

Company Name

Principle/Owner

Person Completing this form

Your e-mail address

Business Contact Information

Please complete the information below for the primary business location. If your business has multiple locations or branches, that information will be collected at a later time.

Primary Phone Number

Primary Fax Number

Primary E-Mail Address

Primary Website Address

Shipping/Location - Address1

Your Shipping/Location address should be where parts orders are received. Additionally, this address will be utilized on our website dealer location listing, so should be where customers will find you to do business.

Shipping/Location - Address2

Shipping/Location - City

Shipping/Location - State

Shipping/Location - Country

Shipping/Location - ZIP

Business Mail/PO Box - Address1

If you utilize a PO Box or have a separate mailing address for business coorespondance, please list that information here.

Business Mail/PO Box - Address2

Business Mail/PO Box - City

Business Mail/PO Box - State

Business Mail/PO Box - ZIP

Additional Contacts

Please supply the contact information for these two key areas where our personnel would have the most significant interaction.

Accounts Payable Manager

Accounts Payable E-Mail

Transland utilizes electronic invoicing. This e-mail address should be where Invoices can be received. Please use a generic address (i.e. Accounting@TranslandLLC.com) if applicable.

Accounts Payable Phone #

Purchasing Manager

Purchasing E-Mail

Please use a generic address (i.e. Sales@TranslandLLC.com) if applicable.

Purchasing Phone #

Tell Us About Your Business

Year Business Opened (under present ownership)

No. of Employees

Number of Locations

Type of Business

Applying to be a Dealer for

(Select each product line you are applying for)

Do you sell via e-commerce?

Competitive Vendors Utilized

Annual Sales (average, US$)

Total Inventory Value (average, US$)

Planned Inventory of Transland Products (US$)

Planned Inventory of CP Products (US$)

Primary Contact at Transland

Credit References

If you have a pre-printed page of Credit References, please attach here and skip to the Authorization section below.

Drop your files here

Trade Reference #1 - Company Name

Trade Reference #1 - Phone Number

Trade Reference #1 - Credit Limit (US$)

Trade Reference #1 - Annual Purchase Volume (US$)

Trade Reference #2 - Company Name

Trade Reference #2 - Phone Number

Trade Reference #2 - Credit Limit (US$)

Trade Reference #2 - Annual Purchase Volume (US$)

Authorization

By filling in my complete name, I hereby authorize Transland to contact the references supplied pertaining to our credit and financial responsibility. All information included in this form or communicated by references will be regarded as confidential information.

Authorization - Print Full Name

Send me a copy of my responses

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