Dealer Form

Fields marked with an * are required

Basics

Enter your legal company name.

Type of Business

Select one or more that apply to your type of business.

Enter the bankers country of your company.

Legal Entity

Select your legal entity type.

Company Information

Enter the street address of your company

Enter the city of your company.

Enter the state of your company.

Enter the province of your company.

Enter the country of your company.

Enter phone number of your company.

Enter email address of your company.

Enter website of your company. eg. www.example.com

Enter the FEiN or resale number of your company. You must also upload the resale certificate below.

Upload the resale certificate and/or tax exemption form of your company... Accepted file formats: PDF, DOC, DOCX, JPG, JPEG, PNG.

Enter VAT Registration Number of your company.

Enter registered name of your company.

Enter registered full address of your company.

Payment Method(s) Requested

Select one or more of the payment methods requested.

Terms

I am the company's owner.

Enter the first name of the signatory of your company.

Enter the last name of the signatory of your company.

Enter the first name of the owner of your company.

Enter the last name of the owner of your company.

Enter the company position of the signatory of your company.

Enter the email address of the signatory of your company.