Dealer Registration

This form is a request to become a registered dealer under V.E. Petersen. Please fill the form out completely and as soon as the request is processed and approved someone will be contacting you.

 

Dealer Registration Request Form

Company Information
Billing Location:
Company Information
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Address
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City
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State
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Zip Code
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Phone Number
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Fax Number
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Years in Business
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Shipping Location:
Company Name
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Address
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City
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Zip Code
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Phone Number
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Fax Number
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Years in Business
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Accounts Payable Information:
A/P Contact
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A/P Email Address
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Business Owner(s)
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Ohio Customers ONLY:
Taxable

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If Non-Taxable (Tax ID#)
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Bank Reference
and Location of School 3
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Address
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City
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State
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Zip Code
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Phone Number
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Contact
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Supplier 1
Name
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Address
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State
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Phone
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Contact
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Fax Number
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Supplier 2
Name
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Address
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State
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Zip Code
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Phone
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Contact
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Fax Number
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Name
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Address
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City
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State
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Zip Code
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Phone
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Contact
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Fax Number
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