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 Monthly eMail Specials? Yes No

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

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:

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

Please note the log in and password must contain a minimum of eight (8) characters and a maximum of twenty six (26).
Password MUST include at least 1 uppercase and at least 1 non alphabetized character

* Preferred Login:

* Preferred Password:

Submit this complete application and email or fax a copy of your state Sales & Use Tax Resale Certificate:

Email: ddemello@defender.com
Fax: 1-800-654-1616

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

* = Required fields