Defender Home Page
Commercial Accounts Application Form
Name of Company:
Billing Address:
City:
State:
Zip:
Email:
Phone:
Fax:
   
Name of Principal Contact:
   
Method of Payment: credit card, check, wire transfer* Credit Card     Check     Wire Transfer    
*Wire transfer customers, please complete the following:
Bank Name:
Address:
State:
Zip:
Phone:
Fax:
Account Type:
Account Number:
 
Authorization:
 
The following individuals are authorized to purchase using this Commercial Account. There is a limit of three names.
Name 1:
Name 2:
Name 3:
   
Business Description:
Marina/Boat Yard
Marine Retailer
Boat Builder/OEM
Charters/Rentals
Yacht Club 		Repair/Service Department
Government or Municipality
Commercial Fishing
Educational Institution
Export
Other: Please Explain:
 

Click here to view our Terms of Sale

Authorized Signature: ______________________________________

Title:

Date:

Fax or mail this application along with:

  1. a copy of your state Sales & Use Tax Resale Certificate
  2. a copy of your company's letterhead

Fax: 800-654-1616 or 860-701-3426

Mail: Commercial Accounts
Defender Industries
42 Great Neck Road
Waterford, CT 06385

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