Reseller Information | Reseller Application

Snorend™ Reseller Application

Several Options: You can complete and submit your application online below, or; fax or mail your application to us by downloading the application in Microsoft Word or Acrobat Reader by right clicking on the Word or Acrobat icons to the right, then click "save target as". Then print, complete and fax to us at the telephone number on the application.	Need Acrobat Reader
	Download Application
	In Acrobat	In Word

Submit Your Reseller Application Online

Thank you for your interest in DocSchmenke products. To be approved as a DocSchmenke Reseller, receive a wholesale Price List (for online quantity ordering), please complete below and click "Submit" to send your application to us for approval. Your application request will be reviewed promptly, and we will be in contact with you.

Please Note: At present DocSchmenke does not offer direct drop shipping to resellers retail customers and is unable to extend wholesale pricing dropship services for product that would be marketed solely on the Internet or to resellers without a permanent “physical” business storefront location (including fairs, home parties, flea markets, etc). If you are unsure about qualifying as a DocSchmenke Reseller, please submit an application. We are happy to review your application and contact you. Thanks.

Company Name:

Country You Are In:

Mailing Address:

City, State (providence), Zip:

Shipping Address:

City, State, Zip:

Buyer Name:

Daytime Telephone Number (s):

Fax Number:

e-Mail Address:

Web site Address:

Resale Permit, Federal, or Tax ID Number: (required)

Type of Retail/Wholesale Operation:
(Select category or use comments box below for details)

Your interest in seeking approval as a DocSchmenke Reseller is: (check all that apply)
To wholesale as a DocSchmenke Distributor
To resell to other businesses in the USA
To represent us as a Manufacturers Representative
To export to other businesses internationally
To retail in your retail store/chain
To retail to customers on the Internet
Other - Please describe:

How long have you been in this business? (check one)
0 -   3 Months
3 -   6 Months
6 - 12 Months
1 -   2 Years
3 -   5 Years
5 - 10 Years
Over 10 Years

Does your business have a "physical" storefront(s)? (check all that apply)
Yes, I listed the location above.
Yes, we have a location but haven't opened yet.
Not at this time, we're thinking about it.
No, we retail through our web site.
Other Method of Retailing (please specify)

How long has your "physical" storefront(s) been open? (check all that apply)
We're not open yet (if the case, check a box indicating when you plan to open.)
0 -   3 Months
3 -   6 Months
6 - 12 Months
1 -   2 Years
3 -   5 Years
5 - 10 Years
Over 10 Years

Does your business have a web site? (check one)
Yes, I listed the site address above.
Yes, it is under construction.
No, we don't have plans for a web site.
Not at this time, we're thinking about it.

I am interested in the following product lines:  (check all that apply)
DocSchmenke Products
Other Sleep Aids

I would like to request the following:  (check all that apply)
Please e-mail me a link to your "printable" Wholesale Price List & Order Form (included w/initial order).
Please contact me by phone, I would like some more information.
Please have a representative contact me for an appointment.
I am interested in placing an order.

Would you be interested in "online" ordering? (check one)
Yes, that would be great!
No, I prefer to call or fax my orders.
I'm not sure, but I would consider it.

How did you arrive at DocSchmenke?

Only complete the following three business credit references if you wish to be considered and approved for a credit line with DocSchmenke. for purchasing DocSchmenke products:

(if no credit line is desired, then skip these business credit references)

Business Credit References

1) Company Name:

Mailing Address:

City, State (providence), Zip:

Contact Name:

Daytime Telephone Number (s):

2) Company Name:

Mailing Address:

City, State (providence), Zip:

Contact Name:

Daytime Telephone Number (s):

3) Company Reference Name:

Mailing Address:

City, State (providence), Zip:

Contact Name:

Daytime Telephone Number (s):

When credit references are checked and your credit line is approved, we will contact you.

Thank you.

I declare that all information provided on this form is correct and true.

Comments, Questions, Suggestions or Additional Information: