Company Name & location

• Company Name
• Address line 1
• Address line 2
• Address line 3
• City
• State --------- Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming If USA, select the state.
• Province --------- Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nunavut Nova Scotia Ontario Prince Edward Island Quebec Saskatchewan Yukon If not USA, select a province here.
• Zip code
• Country United States Canada

Company contact information

• Primary phone This number will be used by resellers to confirm your account. (Format 8008881234)
• Alternate phone Optionally, enter a secondary phone number here. (Format 8008881234)
• Fax number If you have a fax number, enter it here. (Format 8008881234)
• Website Please enter your website's URL here.
• E-mail address If you have an e-mail address, enter it here.

Contacts

• Primary

• • Title } --------- Mr. Ms. Mrs.
  • First name
  • Last name
  • Job title
  • Phone number
  • E-mail address

• Accounting

  Same as Primary
• • Title } --------- Mr. Ms. Mrs.
  • First name
  • Last name
  • Job title
  • Phone number
  • E-mail address

About Your Company

• Tax Id No. (FEIN) Used to validate your submission. Format: 77-7777777
• If other:
• Do you sell Demco products on the Internet?
  • Yes
  • No
• Do you install?
  • Yes
  • No
• Do you have a Demco Point-of-Purchase display?
  • Yes
  • No
• Would you be interested in a free Point-of-Purchase display?
  • Yes
  • No
• Include You in Dealer Search?
  • Yes
  • No
  Would you like your company included in the dealer search on demco.com?
• Business Type
  • RV Dealership
  • RV Parts Store
  • RV Campground
  • Auto Parts Store
  • Auto Repair Shop
  • Aftermarket Accessory Store
  • Automobile Dealership
  • Welding/Fabrication Shop
  • Hitch Shop
  • Body Shop
  • Marine Accessory Store
  • Equipment Rental Store
  • Spray-in Bedliner Installer
  • Internet Reseller
  • Other
  • None of these
  Type of Business (check all that apply)
• Which Products do you Sell?
  • Air Force One
  • Stay-IN-Play Duo
  • Delta Force
  • Tow Bars
  • 5th Wheel Hitches
  • Tow Dollies
  • Other
  • None
  What product families do you sell? (check all that apply)

• Email me a Copy of this Application