Apply to become a Shields, Harper & Co. Customer

Do you think you would be a good fit to become a Shields, Harper & Co. Customer? Tell us about your business and how you you would see the Shields, Harper & Co. products fitting in with your business model.

Please allow up to 2 weeks for a decision to be made on your dealer Application.

Business Info

Name *

Business Website

Phone

Sales Tax I.d.

Street Address *

Address Line 2

City *

State *

Zip *

Please Describe Your Business *

Please Tell Us About Your Business

Contact Info

Primary Contact *

Primary Email *

Accounts Payable Contact

Accounts Payable Email

Default Billing and Shipping Info

We would like to give you the smoothest possible experience when shopping with us!
Fill in your shipping and billing info once, and it will always show up on your checkout forms!

Shipping First Name

Shipping Last Name

Shipping Company

Shipping Street Address

Shipping Address Line 2

Shipping City

Shipping State

Shipping Zip

Use Shipping Information

Billing First Name

Billing Last Name

Billing Company

Billing Street Address

Billing Address Line 2

Billing City

Billing State

Billing Zip

Notes

Password *

Confirm Password *