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Dealer Registartion
Dealer Registration
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Step
1
of
2
50%
Name
*
First
Last
Position
*
Store Name
*
Email
*
Username
*
Password
*
Enter Password
Confirm Password
1. Company Information
Legal Company Name:
*
D.B.A. Name:
*
Your Watershed Group Account Manager:
*
Ship To Address:
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
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Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
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Croatia
Cuba
Curaçao
Cyprus
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Dominican Republic
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El Salvador
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Gambia
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Guinea-Bissau
Guyana
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Heard Island and McDonald Islands
Holy See
Honduras
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Hungary
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India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Kenya
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Korea, Republic of
Kuwait
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Liberia
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Mali
Malta
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Mayotte
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Mongolia
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Montserrat
Morocco
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Nepal
Netherlands
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Nigeria
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Panama
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Poland
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Qatar
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Saint Helena, Ascension and Tristan da Cunha
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Sint Maarten
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Switzerland
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Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
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Tokelau
Tonga
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Virgin Islands, U.S.
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Country
Please Complete The Appropriate Section Below
Business Type
*
Coporation
Sole Proprietorship
Patnership
Date Incorporated:
*
1. Name of Shareholder:
*
Percent of Ownership:
*
Telephone Number:
*
Home Address:
*
2. Name of Shareholder:
Percent of Ownership:
Telephone Number:
Home Address:
3. Name of Shareholder:
Percent of Ownership:
Telephone Number:
Home Address:
Date Established:
Name of Owner:
Telephone Number:
Home Address:
1. Name of Partner:
*
Telephone Number:
*
Home Address:
*
2. Name of Partner:
Telephone Number:
Home Address:
Contact Information:
Buyer Name:
*
Phone Number:
*
Email Address:
*
Accounts Payable Name:
*
Phone Number:
*
Email Address:
*
Credit Card Usage Authorization Form:
Country
*
Canada
United States
Persons Name on Card:
*
Credit Card Type
*
Mastercard
Visa
Credit Card Number
*
Expiration Date
*
CVV
*
Billing Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
IMPORTANT NOTES All transactions moving forward will be billed with the information provided above. 2% surcharge will be added to all invoices when paid using a credit card. Any foreign currency, or prepaid credit card charges that are charged by the issuing credit card provider are the responsibility of the customer. The Watershed Group is not responsible for these charges and accordingly cannot reimburse for same. *If updated credit card information is not given as needed then processing delay's can be expected.
IMPORTANT NOTES All transactions moving forward will be billed with the information provided above. Any foreign currency, or prepaid credit card charges that are charged by the issuing credit card provider are the responsibility of the customer. The Watershed Group is not responsible for these charges and accordingly cannot reimburse for same. *If updated credit card information is not given as needed then processing delays can be expected.