Dealer Application

GearShade is always seeking new distributors of our products. Please fill out the form below, and we will contact you via email.

Company Name: *
DBA Name:
Billing Address: *
Shipping Address: *
Office Phone: *
Fax Phone:
Website Address: *
Facebook Page Address:

Contact Information

Owner Name: *
Owner E-mail: *
Cell Phone: *
General Manager:
Sales Manager:
Accounts Payable:

Company Information

How long has your
company been in business:
Projected Annual Income:
Number Of Locations:
Hours Of Operation:
Company Store Front: *
Number of Product
Lines Handled:
Does your Company
Require a P/O:
List 3 Manufacturer Lines You
Carry and the Year Started:

Bank Information

Bank Name: *
Bank Contact:
Bank Address: *
Bank Phone: *
Type of Account/s Held: *

Additional Information

Fed Tax ID#: *
State Tax ID#: *
How Did You Learn
About GearShade:
Agree: *
By clicking agree, you agree that the information provided is truthful and accurate.
You also agree you are submitting this form on the behalf of a real company entity;
and you have full permission to do so.
Human Verification: