Apply to Become a Distributor

Please, note: credit application process takes time and cannot be completed without all required documentation. If you have an order that needs to be expedited during the credit application process, you may pay by a credit card.

GENERAL INFO
Company Name *
Contact person *
Bill to Address *
City *
State *
Zip Code *
Type of business *
Year business opened
Federal ID# or SS#
Principals name
Website
Credit line requested
Annual sales
Number of employees
Commercial space occupied
How did you hear about ASD
Branch Address *
City *
State *
Zip Code *
Branch Phone *
Email *
Fax
ACCOUNTS PAYABLE
Contact person *
Email *
Phone *
Fax
PURCHASES
Contact person *
Email *
Phone *
Fax
Please, attach a file with references or fill out the table below, minimum of 3 references is required
Attach a File with References
REFERENCES:
Bank Reference (references will be verified)
Bank Name *
Account # *
Address *
Contact Person *
Phone *
Date account opened *
Trade Reference (references will be verified)
Company Name *
Contact Person *
Address *
Phone *
Fax
Email *
Trade Reference (references will be verified)
Company Name *
Contact Person *
Address *
Phone *
Fax
Email *
Trade Reference (references will be verified)
Company Name *
Contact Person *
Address *
Phone *
Fax
Email *
Company
Print your name
Attach W9
Attach resale certificate
The undersigned herby agrees that should a credit account be opened, and in the event of default in the payment of any amount due, and if such account is submitted to a collection authority, to pay an additional charge equal to the cost of collection including court costs. The undersigned individual who is either a principal of the credit applicant or a sole proprietorship of the credit applicant, recognizing that his or her individual credit history may be a factor in the evaluation of the credit history of the applicant, hereby consents to and authorizes the use of a consumer credit report on the undersigned by the above named business credit grantor, from time to time as may be needed, in the credit evaluation process.
ASD COVID-19 Statement