Broker, Agent, Wholesale Application

Thank you for your interest in the LidSitter. We look forward to developing a long-term relationship with your company that will be profitable for us both.
Please fill out the application below in as much detail as possible. We will process your information and get back to you.

* Indicates required field

PURPOSE OF INQUIRY:

Please state intention of inquiry *:

Date *:

COMPANY INFORMATION:

Legal name *:

Doing business as *:

ADDRESS

Street address *:

Line 2:

City *:

State *:

Province/Region:

Postal/Zipcode *:

Country *:

Website *:

Date Established *:

EIN or SS# *:

Business entity *:

CONTACT INFORMATION:

Owner/Officer *:

Name *:

Email *:

Phone Number *:

PROJECTED SALES VOLUME:

Please be realistic when entering your projected volume. This will not affect the outcome of your application, but will help us to manage our production scheduling to avoid delays. One of all of questions below:

SALES

Per month *:

Per quarter *:

Per year *:

SALES CHANNELS

Online Store Sales Channel Details *:

Retail Store Sales Channel Details *:

Direct Response Television Sales Channel Details *: