Reseller Registration Information

Company Name*

DBA Name (if applicable)

DBA Name if applicable: All DBA's or ficticous names that will be used in conjunction with selling Deltran product

Customer Type*

Billing Address*

Shipping Address*

You may add additional shipping addresses in My Account or during the checkout process once your account has been approved.

Same as billing?

Physical Address* (if different from billing address)

Different?

Phone #*

Does your Company plan on selling Deltran products online?

Tax ID (EIN) #*

No Special Characters within Email

Primary Contact*

Buyer Contact

Marketing Contact

Sales Manager Contact

Accounts Payable Contact

General Accounting Contact

Customer Service Contact

Shipping Contact

Is your company associated with any buying groups? If yes, please list the one(s) you are currently purchasing Deltran products from.

Buying Groups

Tax Resale Certification Number

Preferred small package carrier

3rd party billing account number

3rd party account zip code

LTL carrier choice

Collect or 3rd party

Account number if 3rd party

*If no shipping account information is provided Deltran will select the carrier and shipping charges will be added to the invoice.