Dealer Application

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Apply for Dealer Access

Submit your dealer application with company, billing, credit, and trade reference information.

Profile Details

First Name

Last Name

Company

Job Title

Phone

Website

Which best describes your company

Dealer or Partner

Note to PureLink

Company (Billing) Address

Address 1

Address 2

City

State

Postal Code

Country

Account Details

E-mail Address

Password

Confirm your Password

Dealer / Credit Application

DBA(s) used in last ten years

Federal Tax ID#

Resale ID# (for resellers)

Certificate of Resale

Optional for now. Recommended max: 8 MB.

Purchasing Name

Purchasing Email

Purchasing Phone

Number of years in business

Number of Employees

This Year's Estimated Annual Sales

Ownership

Principal1 Name

Principal1 Title

Principal2 Name

Principal2 Title

Trade References

Please list a minimum of two manufacturers/suppliers of which you are a customer.

Reference 1 Company

Reference 1 Company Address

Reference 1 Company Phone

Reference 1 Contact Person / Email

Reference 1 Email

Reference 2 Company

Reference 2 Company Address

Reference 2 Company Phone

Reference 2 Contact Person / Email

Reference 2 Email

Reference 3 Company

Reference 3 Company Address

Reference 3 Company Phone

Reference 3 Contact Person / Email

Reference 3 Email