Please provide the following contact information:

Shipping information:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Cell Phone		Optional
FAX
E-mail
Web Site Address		Optional

Please provide your account information:

Please enter your resale tax ID number or number designating your validity of being a distributor or reseller.

Sales Tax ID Number

Federal ID or social security Number

Billing information if different than shipping:

Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
Cell Phone		Optional
FAX
E-mail

By submitting this form, you are certifying that you are a bona fide distributor or reseller of heat tools and that all of the information above is correct to the best of your knowledge.