First Name *

Last Name *

Email *

Phone

Password *

Password Confirm *

Are you an installer or can you install our products for customers?

Product Interest - Check all that apply *

TRAILERS
ROOFTOP TENTS
READYLIGHT

Company Name *

Company Website *

Company Phone #

Fed Tax ID # *

Do you have a retail location, shop, or e-commerce website? (Select all that apply)

Retail Location
Shop
E-Commerce Website
E-Commerce Website Only
Other

Since you selected "Other" please tell us more about your other location(s):

Yrs. In Business *

Type of Ownership *

Address Line 1

Address Line 2

City

State/Prov/Region

Postal/Zip

Country

Accounts Payable Contact (Name) *

Accounts Payable (Email) *

Owner Name *

Owner - Email Address *

Additional Owner (if applicable)

Additional Owner Email (if applicable)

Reference #1

Acct. Number

Phone/Email

Reference #2

Acct. Number

Phone/Email

If your application is approved, can you provide a sales tax exempt certificate? (If you do not have a sales tax exempt certificate, Freespirit may have to collect sales tax on behalf of your company based on state location.)

The information provided in this application is true to the best of my knowledge *

I agree

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Adventure Series - Replacement Gas Struts for AS49 and AS55

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