Authorized Reseller Application

Please fill out all highlighted fields below.

Company Name	Federal Tax ID #

Physical Address	Mailing Address (if different)

City State/Prov Zip/Postal	City State/Prov Zip/Postal
Country	Country

Primary Contact Name	Primary Contact Title	Primary Contact E-Mail

Secondary Contact Name	Secondary Contact Title	Secondary Contact E-Mail

Phone #	Cell Phone #	Fax #

What year was your business established	Est. Annual Sales of SH Products	Est. Annual Sales of All Marine Electronics

Please list any other company names under which you sell or operate (i.e. DBA):

Please list all company website URLs that you host:

How do you plan to sell Standard Horizon products (please check all that apply)?
Retail Sales/Service Location (If yes, do we list your company on our website?)	Yes    No
Internet Retailer (Auction sites prohibited)	Yes    No
List URL(s) (i.e. Amazon, Newgg, etc.)
Mobile only (sales, installation, service)
Waterfront sales & marine/boat services
Boat and/or engine dealer
Other (please explain):

Please check all boxes that apply to your business:
Showroom	Installations	Technical Service	Mobile	Primarily Internet

Please list the distributor(s) you typically plan to purchase Standard Horizon products from:

Name(s):

By submitting this application, you certify that you have received, read, and understand the Standard Horizon Authorized Reseller Policies and that the information supplied in this application is true and correct. The parties agree to accept a digital image of this signed document as executed as a true and correct original. You further agree that your signature below may appear digitally and is the legally binding equivalent of a traditional handwritten signature.

First and Last Name	Title	Date