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Distributor Application
SJE-Rhombus is a manufacturer who sells to authorized distributors who have supplied a resale certificate. If you would like to be qualified as an authorized distributor, please complete the application form listed below and forward a resale certificate to SJE-Rhombus. A SJE-Rhombus Customer Service Representative will process this application and contact you regarding volume pricing discounts available. If you would rather fax this form to us please print, complete and fax it to 218-847-4617. We look forward to working with you! This form must be completed in English.

Fields Highlighted in RED* are required to send this form.
Company Name*:
Billing Address*:
City*:
State or Country:
Zip or Postal Code*:
Order Acknowledgement E-Mail*:
Invoice E-Mail*:
Phone*:
Fax*:
President/Owner*:
Company ID Number:
Number of years in business*:
Are you a Reseller*:
Number of Employees:
Business Type*:
Anticipated annual sales volume (US dollars) of floats, alarms & panels*:
What industries do you currently supply:
Who do you currently sell to*:
What products do you currently distribute:
Type of credit requesting*:
Estimated monthly credit*:
 
Fill out this section only if the type of credit
you are requesting is an
Open Account or Prepayment.
Please provide a bank reference:
Full Bank Name:
Account Number:
Address:
City:
State or Country:
Zip or Postal Code:
Phone:
Fax:
E-Mail:
 
Please provide trade references:
(All three reference must be entered to complete this application)
Reference #1
Company Name:
Contact:
Address:
City:
State or Country:
Zip or Postal Code:
Phone:
Fax:
E-Mail:
 
Reference #2
Company Name:
Contact:
Address:
City:
State or Country:
Zip or Postal Code:
Phone:
Fax:
E-Mail:
 
Reference #3
Company Name:
Contact:
Address:
City:
State or Country:
Zip or Postal Code:
Phone:
Fax:
E-Mail:
 
Ship to Address: (for products that need to be shipped to a location different that the billing address provided above)
Name/Attn to*:
Phone*:
Street Address*:
City*:
State or Country*:
Zip or Postal Code*:
 
Comments:
     

This form must be completed in English.