| 1. Applicant’s Legal Name: | |
| 2. DBA/Trade Name(s): | |
| 3. Primary Contact: | 4. Title: |
| 5. Company Physical Address: | 6. Company Mailing Address (if different from Physical Address): |
| 7. Telephone: | 8. Fax: |
| 9. Email: | |
| 10. Entity Type: • Corporation • LLC • Partnership • Sole Proprietorship | |
| 11. State of Incorporation: | 12. Year Incorporated: |
| 13. DUNS: | 14. EIN: |
| 15. Resale Certificate Number: | 16. Resale Certificate Issuing State: |
| 17. Applicant may be required to provide invoices or additional supply chain documentation upon request. Please identify all source(s) of the Dalen Products Inc. products you are selling or intend to sell. • Purchase directly from Dalen Products Inc. (Account Number __________) • Purchase from Distributor(s) (list below) • Other (describe below) | |
| 18. Do you store or intend to store your inventory of Dalen Products Inc. products at a location other than the Company Physical Address identified above? • Yes • No — If yes, please provide the address for all locations where such inventory is stored or will be stored: | |
| 19. What state(s) do you intend to sell Dalen Products Inc. products? List below. | |
| 20. Do you use any third-party fulfillment service to store inventory or fulfill orders of Dalen Products Inc. products? • Yes • No — If yes, please identify the name of the fulfillment service and describe the services provided: | |
Requested Websites: Please identify all websites or mobile applications through which you wish to market for sale and sell Dalen Products Inc. products (one per line, exact spelling required).
Example: www.ABCStoreName.com
Example: Amazon.com / Storefront name “ABC Store” / Merchant ID
| Requested Website | Dalen Products Inc. Use Only |
|---|---|
| 1. | • Approved • Declined |
| 2. | • Approved • Declined |
| 3. | • Approved • Declined |
| 4. | • Approved • Declined |
| 5. | • Approved • Declined |
| 6. | • Approved • Declined |
| 7. | • Approved • Declined |
| 8. | • Approved • Declined |
| 9. | • Approved • Declined |
| 10. | • Approved • Declined |
Submitting this application does not authorize applicant to sell Dalen Products Inc. products on any website, mobile application, or third-party marketplace. Authorization is granted only upon written approval by Dalen Products Inc. Dalen reserves the right to approve, deny, revoke, or modify authorization requests at its sole discretion.
Submission of a website or marketplace request does not constitute approval. Resellers are authorized to sell only on approved websites specifically authorized in writing by Dalen Products Inc. Third-party marketplaces, including Amazon, Walmart, eBay, and similar platforms, are prohibited unless expressly approved by Dalen in writing.
