Bean Machine Dealer Application
Company Information
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Business Name: __________________________________________
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Owner/Primary Contact: __________________________________
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Business Address: _______________________________________
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City: _____________________ State: ______ Zip: ___________
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Phone: __________________________
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Email: ___________________________
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Website/Social Media: ___________________________________
Business Details
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Type of Business (check all that apply):
☐ Retail Storefront
☐ Online Store
☐ Repair/Performance Shop
☐ Other: _______________________ -
Years in Business: _______________
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Number of Employees: ____________
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Do you currently sell diesel performance parts? ☐ Yes ☐ No
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Brands you currently carry: ___________________________________
Sales Information
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Average Monthly Parts Sales: $___________________
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Estimated First Order Amount with Bean Machine: $________________
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Sales Tax/Resale Certificate #: ________________________________
References (optional but encouraged)
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Company: _____________________ Contact: ______________ Phone: __________
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Company: _____________________ Contact: ______________ Phone: __________
Agreement
By signing this application, I certify that the above information is true and correct. I understand that submission of this application does not guarantee dealer status and that Bean Machine reserves the right to approve or deny applications at its discretion.
Applicant Signature: ___________________________
Date: _________________
Mail or Email Completed Application To:
Bean Machine
210 Rollin Coal Lane
Woodbury, TN 37190
(615) 563-7800