Bold Industries American Emergency Escape Ladder Manufacturer

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Fire Escape Ladders & Safety Resources

Thank you for your interest in distributing our safety products. Please complete the questionnaire below so that we may learn about your business and so that we will be able to determine which products will be better suited to your business.

NOTE: This form requires payment of $170.00 to complete. Once you have submitted this form you will be taken to the checkout process where you can pay for the processing. Forms without payment will not be processed.

Contact Information

Bank References

Federal Tax ID Number

Bank Name (#1)

Dunn & Bradstreet Number

Address

Principle Officer

City State Zip

Title

Account Type

Legal Structure (check all that apply)

Contact

Corporation	LLC	Sole Proprietor
Partnership	LLP	Non-Profit

Tel

Fax

Business Information
Please list all web site addresses
Do you need images for your website?	No Yes
What customer types are included in your marketing plan? (hardware, house wares, drop-ship, safety, etc.)
What other safety products do you distribute?
Do you have a physical storefront? If yes, where is the store located? (shopping mall, strip mall, independent facility)	No Yes
Do you have a warehouse? Sq.Ft. / # of Employees
Customer Information
From where do you receive most of customer orders? (internet, physical store, drop-ship customer listing, discount purchase groups, etc.)
Do you participate in international marketing? Please explain.	No Yes
Do you accept orders for APO/FPO addresses?	No Yes
Distribution Information
Will you order pallet quantities for warehouse inventory? Do you have specific pallet labeling requirements?	No Yes
Will you require overnight, 2nd, or 3rd day shipping options?	No Yes
Will you require international or APO/FPO drop shipping?	No Yes
Comments / Additional Information

Distributor Kit
Contents: Free Sample Ladder to be used as sales tool.
Reseller DVD	An assortment of hi-resolution and low-resolution image files for product print media and website needs Wholesale Price List with MSRP Shipping Weights & Measures Table Marketing Information	ResQLadder™ 3-rung sample ladder Includes sleeves on one side of the ladder Includes bag of 4 Stand Offs
Signature & Authorization
The signature below represents and warrants that (a) the party signing below is an authorized representative of the company, and (b) that the information provided herein is a complete and accurate representation of the company’s financial situation as of the date hereof. Any misrepresentation or fraudulent information provided will be the basis for default under this agreement. I understand that upon application approval, Bold Industries will process my credit card for the application fee. By signing this form, I expressly authorize Bold Industries to charge my credit card for the Reseller Business Application and agree to all Terms of Service.
Business Title
Print Name		Date

NOTE: This form requires payment of $170 to complete. Once you have submitted this form you will be taken to the checkout process where you can pay for the processing. Forms without payment will not be processed.

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