Business Information

Business Name *

Legal Entity Type *
-- Select -- LLC Sole Proprietorship Corporation Partnership Other

Business Address *

Business Phone *

Website (if any)

Years in Business *

Contact Information

Primary Contact Name *

Title / Role *

Email Address *

Best Way & Time to Reach You

Resale & Tax

Resale Certificate / Tax ID Number

State of Registration

Store Details

Type of Business *
-- Select -- Electrical Supply House Hardware Store Online Retailer Contractor / Trade Industrial Distributor Other

Number of Locations

Storefront Type *
Physical Online Both

Buying Intent

Which Studstix products are you interested in? *
Studstix Wire Dispenser
Mugstix
FormStax
Tracer Chaser
All Products

Estimated Monthly Purchase Volume
-- Select -- Under $500 $500 – $2,000 $2,000 – $5,000 $5,000 – $10,000 Over $10,000

How did you hear about Studstix? *
-- Select -- Trade Show Online Search Social Media Referral from Another Dealer Sales Rep Other

Optional Information

Brief Description of Your Customer Base

Social Media Handles (if applicable)

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