Thank you for your interest in becoming a distributor of BD Loops products. We only sell through distributors, please fill out the form below so that we may verify that you are a distributor before moving forward.


If you would rather download the form to print it
and fax it back to us click here. Thank You!


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BD Loops Credit Application.Type NO or N/A in non applicable boxes.
Company Information

Company Name
Company Website
Contact's Name
Contact's e-mail
Confirm e-mail
Company Address
Company Telephone
Company Fax
Resellers Permit #
Type of Business


Year Established

Owner's Principles

Owner's Name
Address
Telephone
Second Owner's Name
Address
Telephone

Trade References

Company 1:
Company Name
Account #
Address
Telephone
Fax
Contact Name

Company 2:
Second Company Name
Account #
Address
Telephone
Fax
Contact Name

Company 3:
Third Company Name
Account #
Address
Telephone
Fax
Contact Name

Bank Info:
Bank Name
Address
Telephone
Fax
Officer
Account
Loan