Dealer or Distributor Application

01 / Your business and contact

Choose Dealer or Distributor, then provide your legal business and contact details. Required fields are marked *.

Apply as a dealer or distributor *

Legal business name *

Trading name / DBA (Optional)

Business type *

Business website (Optional)

Year established *

Business street or mailing address *

City *

State / province / region *

ZIP / postal code *

Country *

Number of your own retail locations *

Primary contact name *

Contact title / role *

Contact email *

Business phone *

Legal structure (for example: sole proprietor, LLC, corporation) *

U.S. business EIN status *

Employer Identification Number (EIN) *

Business EIN only: 9 digits, with or without a hyphen (XX-XXXXXXX). Do not enter a Social Security number or a personal tax ID.

Business registration / license status *

Business registration jurisdiction / issuing authority *

Owner or purchasing decision-maker — name and role *

02 / Your customers and territory

Supplying only your own stores is a retail account. Distribution means supplying other independent retail businesses.

03 / Your purchasing plan

These estimates help our team discuss account fit. This form does not set pricing, opening minimums, credit terms or approval thresholds.

Estimated opening order — total units *

Estimated first-year purchases — total units *

Estimated opening budget (enter 0 if not yet determined) *

Budget currency *

Expected reorder frequency *

When would you like to start? *

Proposed assortment, quantities and purchasing plan *

Would you also like a volume pricing discussion? *

Ordering / accounts-payable contact — name, business email and role (or same as primary contact) *

04 / Your operating capacity

Tell us what is ready and what is still in development. Enter a business EIN only in the EIN field. Do not enter Social Security numbers, personal tax IDs, bank details, card numbers or identity documents.

Can you hold stock for your customers? *

Can you replenish customer or retailer orders? *

Can your team support calling and call-care education? *

Storage, order fulfillment and shipping arrangements *

Funding for an agreed opening order *

Resale / business documentation status *

How will you introduce the calls and support your customers? *

Trade reference 1 — business, contact and business phone/email (distributors: provide a reference or explain why unavailable) (Optional)

Trade reference 2 — business, contact and business phone/email (distributors: provide a reference or explain why unavailable) (Optional)

I have permission to share any reference contact details provided. If no contacts are supplied, I have explained why. *

Additional information or questions (Optional)

Warehouse / stock location, capacity and typical dispatch time (or readiness plan) *

How will you handle retailer ordering, replenishment, sales reporting and product training? *

Domestic / cross-border shipping, importer responsibility and required permits (state domestic only if applicable) *

Who handles customer issues, returns and replacement-part requests, and how? *

Explain pending / unavailable business or resale documents, or EIN status, and expected availability *

Existing brand / territory commitments or channel restrictions that could affect this relationship (write none if none) *

Would you like to be part of our directory? (Optional)

Directory participation is optional. If your application is approved, MT E.L.K., INC. will notify you about the next steps. If you choose to participate, we will confirm your business listing details with you before publishing.

05 / Review, authorize and send

Review every answer, then authorize the application. Submission does not approve an account, offer credit, or reserve an exclusive territory.

Authorized applicant — type your full name *

Authorized applicant — title / role *

I am authorized to apply for this business and confirm that the information is accurate to the best of my knowledge. *

I agree that MT E.L.K., INC. may store and use this application to review our business inquiry and contact us about it. *

I intend my typed full name above to serve as my signature for this completed application. *

Your typed name, saved date/time, time zone and browser/device details will be included in the application record, PDF and prepared email. Confirm again if you change an answer.

Signature and saved timestamp

Type your full name above and confirm the signature agreement. Save your signature here, or it will be saved when you print, download, prepare an email or submit the completed application.

Signature not saved yet.

This records your stated intent using your device clock and browser-reported details; it does not verify your identity. Netlify records the network IP separately when you submit through the website. The locally saved copy contains browser/device details, not that server IP record.

Email a completed application

Download your PDF and prepare a message from your own email app. You attach the PDF and press Send. This is separate from submitting through the website.

Your completed PDF and email details include your business information and EIN, if provided. Keep them private and check the recipients before sending.

Printing or downloading a PDF does not submit an application. Submit through the website, or prepare an email, attach the PDF and send it from your email app.

When you submit through this website, Netlify stores your application details and shares them with MT E.L.K., INC. for business review and follow-up. Downloading a PDF or preparing an email does not send the application. Answers are not saved as a browser draft. No marketing subscription is required.

Bring the calls.
Build the relationship.

01 / Your business and contact

02 / Your customers and territory

03 / Your purchasing plan

04 / Your operating capacity

05 / Review, authorize and send

Signature and saved timestamp

Email a completed application

Prepare your application email

Bring the calls.Build the relationship.

01 / Your business and contact

02 / Your customers and territory

03 / Your purchasing plan

04 / Your operating capacity

05 / Review, authorize and send

Signature and saved timestamp

Email a completed application

Bring the calls.
Build the relationship.