Dealer Application

Fill out the form below to be considered for Dealer Status with Mr Glass Doors & Windows Manufacturing. Your application will be reviewed and if approved, one of our representatives will contact you directly to let know you what are the next steps and how to take full advantage of our Dealer benefits.

Applicant Information
Applicant*
Please use EXACT registered name.
D.B.A.
Billing Address
Tax ID No.*
Taxable or Tax Exempt
State of Incorporation
Years in Business
Number of Employees
Type of Business
Annual Sales
Website
Email
Phone No.
Fax No.
Owner Information
Legal Owner/Title
Social Security No. (last 4 digits)
Home Address
Phone No.
Legal Owner/Title
Social Security No. (last 4 digits)
Accounts Payable
Contact Name
Phone No.
Email
Fax No.
Shipping Information
Contact Name
Phone No.
Email
Shipping Address
Preferred Shipping Method
- Pick-Up
- Delivery
Is the shipping address a warehouse?
- Yes
- No
Delivery Location
- Loading Dock
- Ground Level
Will there be a forklift?
- Yes
- No
Signature
Legal Owner
Title
Signature

Dealer Application

Applicant Information

Owner Information

Accounts Payable

Shipping Information

Signature