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New Dealer Application
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New Dealer Application
Dealership Information
Note:
This application is intended for brick & mortar retail dealers and does not authorize the sale of Fold-a-Cover products through any internet stores or online auction sites.
Dealer Name
*
Contact Name
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darrussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russia
Rwanda
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
US Minor Outlying Islands
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Phone
*
Email
*
Federal Tax ID# or Resale Tax#
*
Website
Fax
How many locations do you have?
1
2
3
4
5
6
7
8
9
10+
Additional Retail Locations
Name
Address
Additional Business Information
What type of business are you?
Truck Accessory Retail
RV Dealer
Auto Parts Retail
Vehicle Restyle/Converter
Detail/Body Shop
Truck Cap Dealer
How many years have you been in business?
Less than 1 year
1 to 3 years
3 to 7 years
7 to 15 years
15 to 25 years
25+ years
What other tonneau cover brands do you currently carry?
Brand Name
Product Description
Who are your principals or corporate officers?
Name
Address
Phone
Where do you purchase these items from?
Manufacturer
Distributor
Other
Do you have a show room?
Yes
No
What is the square footage?
Please enter a number greater than or equal to
0
.
Do you have installation facilities?
Yes
No
How many bays?
Please enter a number greater than or equal to
0
.
How many installers?
Please enter a number greater than or equal to
0
.
Do you advertise your business?
Yes
No
If Yes, what media do you use most frequently?
Newspaper
Radio
TV
Direct Mail
Sponsorship
Internet
Word of Mouth
Other
Electronic Communication Agreement
Steffens Enterprises, Inc. has implemented a paperless system for acknowledgements, advanced shipping notifications and invoices. These documents are now available to you via e-mail.
*
Please provide electronic contact information for the appropriate documents in the spaces below. If you do not wish to receive an order acknowledgement or advanced shipping notification, please check the box indicating your preference.
I acknowledge that all future acknowledgements, advanced shipping notifications and invoices will be received via email.
Invoice email address
*
Would you like to receive acknowledgement emails?
*
Yes
No
Acknowledgement email address
Would you like to receive advanced shipment notification emails?
*
Yes
No
Shipment notification email address
CAPTCHA
Comments
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