WHOLESALE ONLY - The Bait of the Masters since 1944
Please complete all of the form where applicable. All fields marked with an asterisk * are required. This will help speed your application process. If you have any questions, please give us a call (800) 227-4577
COMPANY INFORMATION
Company Name*
Applicant Name*
Street Address*
City*
State*
ZIP*
How Long at This Address*
Phone*
e-Mail Address*
Website
DELIVERY INFORMATION
Delivery Street Address*
Delivery City*
Delivery State*
Delivery ZIP*
Type of Business*
Select Business TypeBait ShopConvenience StoreOther Retail StoreCommercial FishermanCrabberBird Rehab FacilityCharter BoatOther (must specify
Hours of Operation*
If Other Type of Business, Specify
**For Florida customers, the Florida Fish & Wildlife Conservation Commission requires that you hold a Commercial Saltwater Retail Dealer License to sell saltwater baits. VIEW COMMISSION WEBSITE
Florida Licenses
**Florida RC#
**Florida WD#
Florida SPL#
THE FOLLOWING INFORMATION MUST BE PROVIDED. IT WILL BE HELD IN THE STRICTEST CONFIDENCE.
Ownership (check one)*
CorporationPartnershipIndividual
Check here if in business less than 12 months
Yes
INFORMATION ON COMPANY PRINCIPALS
1st Principal Name*
2nd Principal Name
1st Principal Address*
2nd Principal Address
1st Principal Phone*
2nd Principal Phone
By submitting this form you certify that all the information on this form is correct. You fully understand your credit terms and agree to the proper payment in consideration of extended credit.
Completed By*:
Date:*
Your Title:*