Prodigy Cabinetry Dealer Registration

Full Corporate Name *

Street Address *

Unit, suite, etc

City *

State/Province *

ZIP / Postal Code *

Business E-mail *

Business Phone *

Main Contact Full Name *

Main Contact Title

Main Contact Email Address *

Main Contact Cell Phone

Corporation Type

Tax Status *Non-Exempt (will pay state and federal tax)Tax Exempt

Sales Tax Exemption Number *

*if exempt, please attach copy of State Resale Tax Certificate *

No file chosen

Federal Tax ID Number *

Projected Annual Sales Potential

USD

Other Cabinet Lines Currently Being Purchased

Brand

Annual Purchase Amount

USD

Showroom DisplayYes

Additional Company Representatives to have access to Order Express, the quoting/ordering system

Representative

Cell Phone

Email

Accounts Payable Contact *

Accounts Payable E-mail *

Accounts Payable Phone Number *

Shipping Address

Check if shipping address is same as business address.

Street Address *

Unit, suite, etc

City *

State/Province *

ZIP / Postal Code *

Confirmation of application

Please confirm the information submitted above is correct *Confirmed