Become a Dealer

We are excited that you have chosen our line of products for your distribution and will do our best to see that your decision is both rewarding and profitable.

To set up your account with us, we would appreciate the following information and items

• A completed dealer/distributor registration form (submit information below).
• A brief description of your place of business.

Upon receipt of the above information and approval of your registration, we will be happy to forward to you the dealer/distributor discount information. Please note that there is a $1000.00 minimum initial net order.

Please complete the following dealer/distributor registration form or print and mail to: 

Jorgenson Companies
Attn: Dealer Services
2895 South 300 West
Salt Lake City , UT 84115

DEALER / DISTRIBUTOR REGISTRATION FORM

Please select	Dealer	Distributor
Name
Company Name
Billing Location
Address
City		State	Select One AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip
Phone		Fax
Email
Shipping Location
Address
City		State	Select One AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip
Phone		Fax
Email
Brief Description of Your Business
Preferred Method of Payment		C.O.D. Cash or Check Open Account
What is your effective territorial marketing limits (in terms of states, cities, miles and/or zip codes)?
This territory is catered by
Direct Mail	Media Advertising
Salesperson	Catalog
Other
If you have outside sales personnel, how many?

By entering your name, title and date, you acknowledge that your company is interested in becoming and authorized dealer/distributor, and understand and accept Artograph’s Dealer/Distributor requirements and payment terms.

Name
Date