1. Company Information
Legal Business Name:
DBA (if any):
Corporate Address – Line 1:
Corporate Address – Line 2:
Corporate City:
Corporate State:
Corporate Zip:
Shipping Address – Line 1 (if different):
Shipping Address – Line 2:
Shipping City:
Shipping State:
Shipping Zip:
Main Phone:
General Email:
Website:
Business Type:Corporation LLC Partnership Sole Proprietor
Years in Business:
EIN / Tax ID:
Resale Certificate # (attach copy below):
2. Company Profile
Brief description of your business and who you serve:
Primary industry (select all that apply):
Plumbing Supply Building Supply Kitchen & Bath Showroom Contractor Developer / Builder Retailer eCommerce Other
If "Other" primary industry, please describe:
Markets/Regions Served:
Product Interests (select all that apply):
Kitchen Sinks Bathroom Sinks Faucets Bathroom Accessories Toilets Bathtubs Drains Other
If "Other" product interests, please describe:
Estimated Monthly Purchase Volume:
Under $1,000 $1,000–$5,000 $5,000–$15,000 $15,000–$50,000 $50,000+
Estimated Annual Volume:
Under $10,000 $10,000–$50,000 $50,000–$250,000 $250,000+
3. Key Company Personnel
A. Ownership / Executive Contacts
Owner / Executive 1
Name: Title: Phone: Email:
Owner / Executive 2
Name: Title: Phone: Email:
B. Purchasing Department (Approved PO Contacts)
Primary Purchasing Contact
Name: Title: Phone: Email:
Additional Authorized Buyers
Buyer 1 Name: Buyer 1 Email:
Buyer 2 Name: Buyer 2 Email:
Buyer 3 Name: Buyer 3 Email:
Approved Email Domains for POs (ex: @company.com):
Preferred Ordering Method (select all that apply):
Email PO to orders@dakotasinks.com Phone Website / Portal (future)
C. Accounts Payable
A/P Contact:
Phone:
Email:
Invoice Delivery Preference:
Email Portal Mail
Payment Methods Typically Used (select all that apply):
ACH / Wire Check Credit Card Other
If "Other" payment method, please describe:
4. Logistics & Receiving Information
Preferred Carrier:
UPS FedEx LTL Freight No Preference
Receiving Hours:
Appointment Required?
Yes No
Liftgate Required?
Yes No
Delivery Notes:
5. Additional Business Insight
How did you hear about Dakota? (select all that apply):
Referral Sales Rep Online Social Media Trade Show Other
If "Other", please describe:
Do you have showrooms or display areas?
Yes No
If "Yes", please describe:
Do you (select all that apply):
Resell Install Fabricate Other
If "Other", please describe:
6. Attachments
Please upload any relevant documents below (PDF, JPG, PNG, DOC, DOCX – max 10MB each).
Resale Certificate:
W-9 (optional at this stage):
Any internal vendor forms:
Expected first PO (optional):
7. Authorization
I certify that the information provided is accurate and that the listed individuals are authorized to interact with Dakota Plumbing Products, LLC.
Signature (draw your signature below):
Printed Name:
Signer’s Email (required):
Title:
Date:
