Dealer/Installer Application

We’re excited to grow our family of Dealers and Installers! To apply for wholesale dealer pricing, please complete the following application.

Business Name

Legal Business Name (required)

Contact Information

Phone (required)

Email (required)

Address

Billing Address (required)

Address

Line 2

City (required)

State (required)

Zip Code (required)

Shipping Address (if different from Billing address)

Address

Line 2

City

State

Zip Code (required)

Business Information

Year established:

Type of Business:

Approximate number of customers:

Service area:

Other products represented:

Business Social Media

Facebook link:

Instagram link:

TikTok link:

Tax Status

Tax ID number and state tax certificates are only required if requesting sales tax exemption.

Federal Tax ID#:

State Tax Certificate (Allowable file types JPG, PNG or PDF. Size limit 5MB):

Business Principals: Names of Officers or Owners

Principal 1

Name (required)

Position (required)

Principal 2 (if applicable)

Name

Position

Principal 3 (if applicable)

Name

Position

References

Trade/Credit Reference 1

Reference Name (required)

Phone (required)

Email (required)

Account #

Trade/Credit Reference 2

Reference Name (required)

Phone (required)

Email (required)

Account #

Trade/Credit Reference 3

Reference Name (required)

Phone (required)

Email (required)

Account #

Bank Reference

Primary Bank

Bank Name (required)

Phone (required)

Email (required)

Account #

Authorization

Person Making Application (required)

Title (required)

By submitting this application, you affirm that you are authorized to act on behalf of the business listed above. Furthermore, you agree to allow SnirtStopper LLC, the corporate owner of SnirtStopper.com, to contact and request information pertaining to the above listed business from the references submitted insofar as it pertains to your SnirtStopper.com dealer account status.

Submitting this application is no guarantee of obtaining Dealer or Installer status or special pricing.

Please leave this field empty.