NHS DEALER APPLICATION

Thank you for your interest in becoming a Dealer of NHS Products. Please take the time to fill out this application completely and accurately. If you have any questions, please contact us at Sales@nhs-inc.com

Company Information

Business Information

 
Business Name / DBA: Business Phone:
Address 1: Location Since:
Address 2: Year Established:
City: Parent Company:
State: Sellers Permit #:
Zip: Type of Store:
  Business Type:

Shipping Address ( if different than above )

Name : AP Contact Name:
Address 1: AP Contact Phone:
Address 2: AP Contact E-Mail Address:
City: Buyers Contact Name:
State: Buyers E-Mail Address:
Zip: Buyers Mobile Phone:
  Company Website:
  Facebook:
  Instagram:
Currently Buy From : AWH Eastern Ocean Avenue South Shore OTHER :
Brands Carried:

Ownership

Please review the following information.

Principal Owner Information

Bank Information

First & Last Name *: Name :
Address 1: Contact:
City: Account:
State: Phone:
Zip:  
Email *:
SS#:
Phone:
Authorized Agent. Person who will sign the Application.

References

Please review the following information.

Quick Reference DC Shoes Deluxe Dwindle/Globe Eastern Element Girl/Chocolate
Checks: Oakley Skateone Sole Tech Tum Yeto Vans Volcom

Credit Reference 1

Credit Reference 2

Credit Reference 3

Company Name:
Contact Name:
Phone:
Email:

1.800.543.7979     © 2008-2015 NHS, Inc