DEALER APPLICATION

BECOME AN AUTHORIZED IMER DEALER

1. Billing Information

2. Shipping Information

3. Company Bio

4. Products & Business Type

I want to sell the following products (check all that apply):
My company is (check all that apply):

5. Owners / Partners / Officers

Owner 1

Owner 2

6. Contacts

AP Contact

Marketing / Sales Contact

7. Banking Information

Bank 1

Bank 2

Bank 3

8. Trade References

Reference 1

Reference 2

Reference 3

9. Document Uploads

Please upload your completed, signed W-9. Need a blank copy? Download the official IRS W-9 here.
Download IMER USA's W-9 for your records

Click to browse or drag & dropPDF, JPG, or PNG — max 10 MB

Upload your State Sales Tax Resale Certificate

Click to browse or drag & dropPDF, JPG, or PNG — max 10 MB

10. Certification & Signature

I certify that the information above is true and correct and that I can and will comply with the terms and conditions of such credit extended. In making this application for credit, the CUSTOMER agrees to pay all invoices within 30 days from the date of invoice or within the terms of each invoice. The CUSTOMER also agrees to pay a service charge of 1.5% per month for every month on overdue balances. In the event that a suit or collection agency becomes necessary, I PERSONALLY GUARANTEE PAYMENT OF THIS ACCOUNT. The CUSTOMER agrees to pay the seller's reasonable attorney fees and/or cost of collection. Must be signed by a principal in the company.