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Become a Houseworks Dealer

Please provide the following information, and we will begin the process of registering you as a Houseworks dealer. You will be contacted by phone or email, within 2 business days, by a Houseworks representative. Thank you.


Date:
Name of Business:
First Name:
Last Name:
 
Business Address:
City:
State:
Zip:
Country:
Business Contact Phone:
 
Preferred Shipping Method: UPS
FedEx
Other
 
Shipping Address Is A: Business Address
Residential Address
 
Shipping Address:
City:
State:
Zip:
Country:
 
Alternate Phone:
Fax:
 
Your Website:
 
Email Address:
Confirm Email Address:
Password for This Account:
Passwords should be 6-10 lowercase letters or numbers. No spaces.
 
This is in regard to : Corporation
Partnership
Proprietorship
 
Type of business:
(select as many as apply)
Storefront
Internet
Manufacturer
Artisan
Distributor
Shows
 
Payment type: VISA
MasterCard
Discover
American Express
Check
 
  Transactions Protected By:
  

Credit Card #:
Expiration:
CVV:
Name on Card:
 
Number of Stores:
Year Business Started:
Tax Number:
Business License:
 
Comments:
 
 

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