New Dealer Application

Thank you for your interest in becoming a part of the Bremtown Dealer Network! This application form gathers all the information that we need completed to ensure a successful dealer setup. We will use this information to establish our working relationship, your Order Express profile, and financial account with Bremtown Cabinetry.

Please review and complete the forms in their entirety. Incomplete forms may delay the approval of your Dealer Application. If you have any questions while completing this form, please feel free to contact your Sales Representative or our Accounting Office at 574-546-2781 or accounting@bremtown.com.

What happens once you submit your application to Bremtown? We will review your information, contact your references, establish your Order Express and financial account. Once this process has been completed, you will receive two letters from Bremtown:

A Welcome Email with your Order Express Login Credentials
A Welcome Letter from our Accounting Office outlining payment terms and any other financial account information

Business Information

Legal Business Name:

Business Name (DBA):

Business Address:

City:

State:

Zip:

Business Phone:

Business Email:

Website:

Showroom Address:

Leave empty if same as business address

Business Type

The following information MUST be provided. It will be held in the strictest of confidence.

Business Type:

State of Formation:

Date Business Established:

Ownership Information

Please provide a list of owners for your company. The names listed below must equal 100% ownership.

Owner Name:

Owner Title:

Ownership %:

Owner Phone:

Owner Email:

Create an Order Express user for this owner:

Staff and Designer Information

Add contact details for your Primary Contact and additional staff members as needed.

Use Owner as Primary Contact:

Primary Contact Name:

Primary Contact Title:

Primary Contact Phone:

Primary Contact Email:

Create an Order Express user for this person:

Secondary Contact Name:

Secondary Contact Title:

Secondary Contact Phone:

Secondary Contact Email:

Create an Order Express user for this person:

Accounting/Invoice Contact

Bremtown requires one or more email addresses for sending invoices. Please provide addresses that are monitored regularly. Note that no paper copies of invoices will be mailed.

Use Primary Contact as Accounting Contact:

Accounting Contact Name:

Accounting Contact Phone:

Accounting Contact Email:

Secondary Accounting Contact Name:

Secondary Accounting Contact Phone:

Secondary Accounting Contact Email:

Primary (Job Delivery) Address

Specify a separate address for job delivery.

Use Business Address for Job Delivery:

Job Delivery Business Name:

Job Delivery Contact Name:

Job Delivery Address:

Job Delivery City:

Job Delivery State:

Job Delivery Zip:

Job Delivery Phone:

Job Delivery Email:

Delivery Address Type:

Small Package (UPS) Delivery Address

Specify a separate address for UPS delivery. If omitted, the main company address will be used.

Use Business Address for UPS Delivery:

UPS Delivery Business Name:

UPS Delivery Contact Name:

UPS Delivery Address:

UPS Delivery City:

UPS Delivery State:

UPS Delivery Zip:

UPS Delivery Phone:

UPS Delivery Email:

Business References

Please provide supplier / vendor references – preferably one cabinet manufacturer.

Business Name:

Address:

Phone:

Email:

Business Reference Signature Authorization

The undersigned represents they are authorized to provide the above reference information on behalf of the business entity. The undersigned also authorizes their business references to release any information requested to assist in establishing business integrity with Bremtown Fine Custom Cabinetry, Inc.

I accept the Business Reference Signature Authorization:

Cabinet Lines in Your Showroom

Name:

Est. Annual Spending:

Sales Representative

Bremtown Sales Rep: