Become a Dealer - Peters Distributing

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This field is for validation purposes and should be left unchanged.

Legal Company Name(Required)

Doing Business As

Business Address(Required)

Address City State ZIP Code

Phone Number(Required)

Cell Number

Email Address(Required)

Main Contact Name(Required)

Person(s) authorized to place orders

First Last

When Is The Best Time For Us To Contact You Pertaining To Ordering

i.e. Tuesday AM is good or Truck Day is Thursday Please do Not Contact on Thursday etc.

Tax Exemption Certificate(Required)

Please attach proof of tax exemption for your business. Exemption form required before products will be shipped.

Drop files here or

Max. file size: 32 MB.

Billing Details

Same as Legal Company Information

Billing Name(Required)

Billing Address(Required)

Address City State ZIP Code

Billing Contact Name(Required)

First Last

Billing Phone Number(Required)

Billing Email(Required)