Become an American Tubs Dealer

Company Name *

Company Website *

Contact Name *

Contact Direct# *

Contact Cell# *

Contact Email *

Billing Address *

Shipping Address *

Business Phone# *

Type of Business *

Fed Tax ID# *

Sales Tax ID# *

Do you have a retail store?

yesno

Do you plan to have a unit in your retail store?

yesno

How many Walk in Tubs do you project to sell a month?

What products do you currently sell?

Does your company providing install services?

References

Reference 1 Contact Name

Company Name

Address

E-mail

Phone Number

Reference 2 Contact Name

Company Name

Address

E-mail

Phone Number

Reference 3 Contact Name

Company Name

Address

E-mail

Phone Number

Authorized Representative