New Dealer Application

Use this form to apply to become a U-Dump dealer.

Contact

Company Ship to Location

Company Name

Doing Business As (DBA)

Address Line 1

City

State

Zip Code

Telephone

Fax

Website

Company Sold to Location

Dealer Name

Dealer Number (Must have a current dealer number)

Dealer Address Line 1

City

State

Zip Code

Names of Officers / Partners or Salesperson

Owner Name

Title

Telephone

Owner Name

Title

Telephone

Trade References

Owner Name

Title

Address Line 1

City

State

Zip Code

Bank References

Bank Name

Telephone

Bank Address Line 1

City

State

Zip Code

COD or Floor

Acceptance of Material or Service on your part constitutes agreement incurred in the collection of payment for same. If credit is extended for replacement parts, any amount remaining beyond agreed upon terms as printed on the invoices in question are subject to a service charge of 1½% per month. All new trailers are sold COD and payment will be collected at the time of delivery or before. Applicant agrees to all of the Terms and Conditions of Sale as stated above.

Electronic Signature (please enter first and last name)

By checking this box, I confirm the accuracy and truthfulness of the information provided.