Dealer Application

Your subscription could not be saved. Please try again.

Thanks for completing this application. We will review and contact you with next steps.

Dealer Application

Company Name

Contact First Name

Contact Last Name

Business Street Address

Business City

Business State or Region

Country

Business Postal Code

Business Phone Number

Business Fax Number

Website URL

Owner Full Name

Shop Shipping Address

Shop Shipping City

Shop Shipping State or Region

Name of bank

Full bank address

Type of bank account

Number of years with bank

Trade reference 1 - Name of firm

Trade reference 1 - Full address

Trade reference 1 - Email

Trade reference 1 - Phone number

Trade reference 2 - Name of firm

Trade reference 2 - Full address

Trade reference 2 - Email

Trade reference 2 - Phone number

Trade reference 3 - Name of firm

Trade reference 3 - Full address

Trade reference 3 - Email

Trade reference 3 - Phone number

BAKER is committed to protecting and respecting your privacy, and we’ll only use your personal information to administer your account and to provide the products and services you requested from us. From time to time, we would like to contact you about our products and services, as well as other content that may be of interest to you. If you consent to us contacting you for this purpose, please tick below to say how you would like us to contact you:

I agree to receive other communications from BAKER.

In order to provide you the content requested, we need to store and process your personal data. If you consent to us storing your personal data for this purpose, please tick the checkbox below. I agree to allow BAKER to store and process my personal data.*

I agree to allow BAKER to store and process my personal data.*