Become a Reseller

Legal Business Name

Date

DBA or other name used

Sole Proprietorship Partnership Corporation Other

State

Billing Address

Phone

Fax

Shipping Address

Phone

Fax

Name

Federal Tax I.D #

E-mail

DNB #

Website

Resale Certification #

Attach Resale Certificate

YOU MUST ATTACH YOUR RESALE CERTIFICATE WITH THIS NEW ACCOUNTS APPLICATION **IF YOU DO NOT ATTACH YOUR RESALE CERTIFICATE, YOUR ACCOUNT WILL NOT BE PROCESSED

Quick Links

Contact

Call Us

+1 561-618-9955

Mail Us

sales@mtcprimellc.com

Visit Us

Delray Beach, FL – United States

Customer Service

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