New Dealer - Order Assistance

Yes, please add me as a New Dealer of Montana Pitch-Blend Products!*

Dealer Name (Store or Business Name)*

Contact Name (Your Name or Buyer's Name)*

Contact's Phone Number*

Dealer Shipping Address (ship-to location)*

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Billing Address is Same as Ship-To

Dealer Billing Address (mailing address)

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Email Address (for shipping confirmation)*

Select preferred Method of Payment*

Visa/Mastercard

American Express

Discover

COD

Select Item(s) For This Order Quote*

Leather Dressing 4oz Jars (1 Case of 12 units)

Leather Oil 8oz Bottles (1 Case of 12 units)

Leather Oil Soap 8oz Bottles (1 Case of 12 units)

Leather Dressing Tub (52oz unit)

Leather Dressing 12oz Mini-Tubs (1 Case of 4 units)

Leather Oil Gallon (128oz unit)

Leather Oil Quarts (1 Case of 4 units @ 32oz each)

Leather Oil Soap Gallon (128oz unit)

Leather Dressing Sample Pack (24 units @ 1/2-oz each)

I NEED MORE UNITS THAN SPECIFIED HERE, PLEASE CALL ME.

Dealer Business License*

Federal Tax ID

State Tax ID or Business License Number (if appliable)

Dealer Region (US or International)

U.S. Only

North American (US, Canada, and Mexico)

Canada Only

International (Country outside U.S. and North America)

Years in Business?

What leather goods do you sell primarily?

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Your Comments/Questions?

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