Dealer Reseller Application - Roscoe Medical 2025

1. Click ‘Get Form’ to open the Dealer Reseller Application in the editor.
2. Begin by filling out the 'General Information' section. Enter your Business Name, Primary Contact Name, Phone Number, Fax Number, and Email Address. Ensure all details are accurate for effective communication.
3. Indicate your business structure by selecting from options like Sole Owner, LLC, Corporation, etc. Provide the necessary identification numbers such as Fed Tax ID or SSN and DUNS #.
4. In the 'Billing Information' section, enter your Billing Address, City, State, Country, and Postal/Zip Code. Include an Accounts Payable Contact and their phone number for billing inquiries.
5. Complete the 'Shipping Information' if it differs from billing. If they are the same, check the corresponding box to save time.
6. Review all sections thoroughly before signing at the end of the document to certify that all information is true and correct.

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