Become a Dealer - Kessick Wine Cellars

I am a...*
Name*
First Last
Company Name*
Tax ID#*
Retail License#
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Mobile*
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Federal ID
Email*
Website*
Do you have a showroom?
Do you feel like a showroom display would help you sell our product?
How many sales/designers on staff?
Sales/Designers
Sales/Designer Name Sales/Designer Email Sales/Designer Email Sales/Designer Email

List sales/design staff if applicable
How did you hear about Kessick?*
Name of Manufacturer's Rep
Primary Interest
What design software do you use? Chief Architect, SketchUp, DWG files available upon request
Define your geographical territory*
What product lines do you sell?
Tell us about your company and why you think Kessick is a good fit*
Trade References*
Company Name Address Telephone Fax
By signing this agreement, you are acknowledging you understand Kessick’s Design Fee and Payment Policies and that Kessick Wine Storage Systems’ catalog, photos, pricing and order form are the property of Kessick and are not to be copied or distributed without permission.
Upload company logo for design presentations (Optional)
Accepted file types: jpg, jpeg, png, pdf, Max. file size: 20 MB.
Authorized Signature*

Sales/Designer Name	Sales/Designer Email	Sales/Designer Email	Sales/Designer Email

Company Name	Address	Telephone	Fax