Wholesale Account Government Procurement Step One

Please note, a minimum of $100.00 is required for all non-drop shipped wholesale orders. Rothco reserves the right to refuse or add a $20.00 service charge for orders under $100.00.

* Company Name :

* Federal Tax ID # or State License # (Non U.S. Companies Please Enter Country Name Below) :

* Mailing Address 1 :

Mailing Address 2 :

* City :

* State/ Province :

* Zip/Postal Code :

* Country :

* Is this a Commercial or Residential address :

* Please Take a Brief Moment to Describe Your Business :

Company Website :

* Email Address :

* Primary Contact Name (Full Name) :

* Primary Contact Title :

* Business Phone Number :

* Mobile Phone Number :

* How Did You Hear About Rothco :

* Please Specify :

* Company Total Annual Sales (US $) :

* Invoice Method : Mail

Email

If email please specify address :

If you are experiencing issues completing this form please email DealerAcctSetup@Rothco.com

Rothco does not accept new Amazon and eBay accounts. All companies that wish to sell ROTHCO product online must have a fully functional ecommerce website that has been active for more than one year.

Please click submit to move to the next form. Failure to complete the second form will result in delayed processing of your wholesale account request!

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