Dealer Registration Form

Become an Authorized Dealer!
Please provide all required details below to qualify your business with us. If your company qualifies to become a dealer, a StopBox USA representative will be in contact with you to discuss further opportunities. Thank you for your interest in the StopBox USA Dealer Program.
Applicant Name *

First Name Last Name
Business Name *
Contact Number *

Area Code Phone Number
E-mail *
Company Website *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Is this for Domestic or International Wholesale? *

Domestic International
Store type *

Brick & Mortar Online Both None
Federal Tax ID - (EIN) Employer Identification Number *
Type of Business *
How long have you been in business? *
Please provide a short description about your company. *
Please list the products that you service/sell. *
What market do you service? What is your geographic reach? *
What is the estimated annual sales volume with our products? *
Reseller Permit

Browse Files

Cancel of
Please describe your current interest level in becoming a StopBox USA Dealer. *

Ready to buy today Looking to start selling in in the next 3 months Looking to start in 6 months Looking to start in 12 months Currently just researching for dealer opportunities
How did you hear about us? *
If Other was selected above, please specify here:
Should be Empty:

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Become an Authorized Dealer!