Commercial Accounts Application Form

Company Information (*=required)

* Name of Company:

Type of Company:

DBA Name:

Federal Tax ID:

* Business Type:

* Years in Business:

* Billing Address:

* City:

* State:

* Zip:

* Email:

Company Website:

* Phone:

Fax:

* Name of Principal Contact:

Preferred Method of Contact:
Email Phone

Would you like to receive our eMail Specials? Yes No

If you ship outside of the USA do you use a freight forwarder Yes No

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:

Repair/Service Department
Government or Municipality
Commercial Fishing
Educational Institution
Export

Other: Please Explain:

Click here to view our Terms of Sale

If your billing address is within the USA please fill out the following if you wish to purchase via www.Defender.com

Your login will be your email address and your temporary password will be emailed to you.

Submit this complete application and email a copy of your state Sales & Use Tax Resale Certificate to: comaccounts@defender.com

Please note applications are normally processed within 72 hours of receiving a completed application

* = Required fields