Dealer Application

Business Profile

Tell us about your company and primary contact.

Company Name *

Company name is required

Website

Please enter a valid URL

Billing Address *

Address is required

City *

City is required

State *

Enter 2-letter state code

Zip *

Enter valid zip code

Contact Name *

Contact name is required

Title

Email Address *

Enter a valid email address

Phone Number *

Enter a valid phone number

Verification

Upload the required documents for dealer verification.

Resale Certificate Required PDF, JPG, PNG (max 10MB) Download Blank Form

Business License Required PDF, JPG, PNG (max 10MB)

W-9 Form Required — Click to fill out We'll pre-fill from your application Download Blank W-9

Preferences

Set your payment and communication preferences.

Payment Preferences

Apply for Net 30 Terms

Request credit terms (subject to approval).

Purchasing Information

Principal Purchasing Contact *

Required

Phone Number *

Required

General Accounting

Owner/President Name *

Required

Owner Phone *

Required

Accounts Payable Contact *

Required

Email for Invoicing *

Valid email required

Financial Information

Bank Name *

Required

Bank Contact Name *

Required

Bank Phone *

Required

Bank Address *

Required

City *

Required

State *

Required

Zip *

Required

Trade References

Reference 1

Business Name *

Required

Contact Name *

Required

Phone Number *

Required

Address *

Required

City *

Required

State *

Required

Zip *

Required

Reference 2

Business Name *

Required

Contact Name *

Required

Phone Number *

Required

Address *

Required

City *

Required

State *

Required

Zip *

Required

Reference 3

Business Name *

Required

Contact Name *

Required

Phone Number *

Required

Address *

Required

City *

Required

State *

Required

Zip *

Required

Communication Preferences

New Product Launches

Be the first to know about new arrivals and collections.

Promotions & Special Offers

Exclusive discounts and limited-time dealer incentives.

Sales & Marketing Updates

Selling tips, marketing assets, and sales program announcements.

Training & Resources

Product guides, installation tips, and dealer training materials.

W-9 Certification

W-9 Instructions

U.S. Form W-9

Request for Taxpayer Identification Number and Certification

Rev. March 2024 · irs.gov/FormW9

Section 1

Identification of Beneficial Owner

1. Name (as shown on your income tax return) Auto-filled

2. Business Name (if different from above)

3A. Federal Tax Classification

4. Exemption Status

Exempt Payee

Non-Exempt Payee

5. Business Address

Auto-filled

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Requester's Name & Address

BEX Products, Inc.

1301 N Broadway STE 32595
Los Angeles, CA 90012

Part I

Taxpayer Identification Number (TIN)

Enter your TIN. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). For an S Corporation or other entity, it is your employer identification number (EIN).

If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter.

Employer Identification Number (EIN)

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Part II

Certification

The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

Certification

Under penalties of perjury, I certify that:

1.The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2.I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the IRS that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and
3.I am a U.S. citizen or other U.S. person (defined below); and
4.The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.

Under penalties of perjury, I certify the statements above.

Beneficial Owner (or individual authorized to sign for the beneficial owner)

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Contact · BEX Products, Inc.

From Dealer Application

Who is authorized to sign this certificate?

W-9 Submitted

Your W-9 has been signed and submitted to BEX Products, Inc. A copy will be sent to your email on file.

Signed by—

BusinessBEX Products, Inc.

Date—

FormW-9 · Rev. March 2024