New Dealer Form

ZT Dealer Registration Form

* Indicates required field

Name of Business *

ZT Sales Representative *

Billing Address *

Shipping Address (if different) *

Telephone Number *

Tax ID (U.S. only) *

Owner Name *

Ship To Telephone Number (if different) *

Reseller's Permit No. *

Owner Email *

Buyer Contact Name *

Buyer Contact Email *

Shipping/Receiving Contact Name *

Accounts Payable Contact Name *

Shipping/Receiving Contact Email *

Accounts Payable Email *

Carrier *

Account # *

Payment Terms Options *

Prepay Net 30 (must submit references below)

Name of Business (1) *

Contact Name (1) *

Contact Email (1) *

Contact Telephone (1) *

Name of Business (2) *

Contact Email (2) *

Contact Name (2) *

Contact Telephone (2) *

Submit