"If our approach to distribution sounds interesting to you we would love to talk to you more about what we offer and keep you updated on our progress. Please send an email or give us a call whenever it is convenient for you."

 

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Reseller Application Form

Fill out this form to be added to our reseller list and to gain access to our reseller pricing. We will contact you shortly with more information.

  • Dr. Bott LLC is dedicated to serving resellers.
  • Compelling, quality products.
  • Same day shipping on most orders placed before 2:00 pm Pacific time.
  • Reseller pricing with reasonable margins.
  • Knowledgeable sales staff.
  • Growing product line.
Required fields are marked with an asterisk (*)
Company Information:
Billing Information Default Shipping Address
Company Name: *
Company:
Attention:

Address: *

Attention:

Address:
City: *
City:
State/Prov:*

Zip/Postal:*
State/Prov:
Zip/Postal:
Country:
Country:
Phone:* Fax:
Web Site: Tax ID#:

Please enter contacts who we should keep updated with current pricing and new product information:
Your Name *
Title
Email *
Phone/Ext
Name
Title
Email
Phone/Ext
Name
Title
Email
Phone/Ext
Name
Title
Email
Phone/Ext
Name
Title
Email
Phone/Ext
Name
Title
Email
Phone/Ext
Accounting Contact:
Acct. Contact
Acct. Title
Acct. email
Acct. Phone

What makes your company special?
How can Dr. Bott serve you?
Do you have any other comments?
How many employees at your location?
How many employees in your whole company?



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