Partner Program Application

Please type all information
COMPANY INFORMATION
Company Name: Company Website:
Company Phone: Company Fax:
PRIMARY CONTACT
Contact First Name: Contact Last Name:
Contact Title:
Contact Email Address: Contact Cell Phone:
BILL TO
Bill To Address:
Bill To City: Bill To State:
Bill To Zip: Bill To Country:
SHIP TO (Used only for standard shipments to Partner. Ship to will be confirmed for each order)
Ship To Address: 
Ship To City: Ship To State:
Ship To Zip: Ship To Country:
BUSINESS INFORMATION
Number of years in business:
Do you have a retail store? Yes     No
Do you employ or contract installers? Employ     Sub-contract     Both     Neither, we do not offer installation
Type of Company? Corporation     LLC     Sole Proprietor     Partnership     Other
Company Fed ID# or SSN:
Business Insurance Carrier: Policy #:
Local Business Permit #:
Local Reseller Permit #:
What product/services do you provide?
Describe your target market?
How do you market your company?
What goals do you have in becoming a Handi-Ramp partner?
What questions do you have for Handi-Ramp?
You may also fax this form to (847) 816-8866