UniPAT Products Tenn-Sportsman Video Eyewear, Norton Sharpening Stones and More

Application for Retail Distribution

Items in RED are Required Fields

Business Information Business Name

Business Address 1

Business Address 2

Business City

Business State

Business Zip Code

Shipping Address

If shipping address is the same as Business Address, Check this Box
{Do Not Fill in Shipping Address if Box is Checked}

Shipping Address 1

Shipping Address 2

Shipping City

Shipping State

Shipping Zip Code

Business Contact Info Business PhoneDigits & Dashes Only

Personal Cell PhoneDigits & Dashes Only

Email

Contact Name

Additional Information Number of Retail Outlets

Are You a Govt Entity?

Approx. Number of Units Needed in First Order

Username Requested

Enter a username that you would like to use to login to our system (8-16 characters). You will be given a password upon activation.

Answer the following question.
If the grass is green, what color is the sky?

This helps prove that a human is filling out the form and prevents automated spam.

Please allow 48 hours for a reply from someone from the UniPAT Staff to contact you to discuss business matters.  A copy of your business license and reseller tax exempt paperwork is required for consideration.  Please have all paperwork ready to fax when you are contacted.  Additional paperwork will be required if your organization wishes to set up a Net-10 or Net-30 account.  If this is your desire, please send an email to lisa@unipatproductstenn.com so we can forward the appropriate paperwork to you.         PLEASE NOTE:  By sending this application request, you are agreeing NOT to sell any product at below Minimum Advertised Prices, which will be discussed upon approval.  Violating this hurts all resellers and will result in immediate revocation of reseller privileges.

Please fill in the fields above. We will contact you as soon as possible. You may also contact us by
calling (931)649-2447.
Thank you!