Dealer Application

Quick Dealer Application

This application is reserved for customers that have been in business for more than one year. Please fill in the following questions that apply and submit.

Your information is sent via our secure server and is only used for the purpose of establishing a business relationship with The Horizon Group. You may also print the completed form and fax it to: 856-582-5399. Most applications are processed within 24 hours.

Dealer Information

Company *

Federal ID# *

Website

First Name *

Last Name *

Email *

Accounts Payable Contact Name *

Email For Accounts Payable *

Phone *

Fax

Street Address 1 *

Street Address 2

City *

State *

Postal Code *

Bank Name *

Bank Address *

Bank City State Zip *

Bank Account Number

Bank Phone Number *

Bank Primary Contact *

May we contact your bank if we need to? *

Yes

Credit Card Account #

Expiration Date

Name on Card

Bill to Address of Credit Card

Do you wish to use this card every time?

Yes

Resale Certificate # *

Are all purchases exempt? *

Yes

Markets Served * Select all that apply by clicking and holding the control key.

Digital Signature

Your digital signature approves us to check you credit and extend you terms.