New Authorized Dealer Application

 

Business Information

Business Name*
Website
General Phone*
Business License Number*

Contact Information

Contact Name*
Contact Email*
Accounting Phone*
Accounting Email*

Billing Address

Address*
Address 2
City*
State*
Zip*

Shipping Address

Use Billing Address

Address*
Address 2
City*
State*
Zip*

Other Information

How long have you been in business?*
How many Central Systems do you
install per year?*
What type of power units do you sell?*
Other information?
 
 
Thank you for your interest in Hide-A-Hose.
If you have questions or comments, please feel free to contact us.

Contact Hide-A-Hose

14490 167th Ave SE, Monroe WA 98272 USA
360-863-0775 | 877-851-4491