Partnership Application

Application Type Application TypeDealerInstaller

First Name

Last Name

Company Name

Email

Email

Work Phone

Address 1

Address 2

City

State StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Business Website

Type of Business

EIN #

Sales Tax ID#

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

What products do you currently sell?

Do you have a retail store? Do you have a retail store? Yes No

Do you plan to have a unit in your retail store? Do you plan to have a unit in your retail store? Yes No

Will your company provide installation services? Will your company provide installation services? Yes No