BioLite Dealer Application

Please fill out this form for Dealer Application. For any questions please contact your sales rep or DealerServices@BioLiteEnergy.com.

Company Name

Reseller ID Number/Tax Exempt Certificate

Website

Phone

Account Payable Email Address

No. of Store Locations

Credit Amount Requested (See Below)

Estimated Annual Sales

No. Years in Business

Type of Ownership

Attach Vendor Compliance Or Routing Guide

Preferred Shipping Carrier Account Number

Billing Information

Billing Address Line 1

Billing Address Line 2

Billing City

Select Your Billing State

Billing Zip Code

Select Your Billing Country

Shipping Information

Shipping Address Line 1

Shipping Address Line 2

Shipping City

Select Your Shipping State

Shipping Zip Code

Select Your Shipping Country

Buyer Information

Primary Contact (Buyer) First Name

Buyer Last Name

Buyer Email

Buyer Title

Buyer Phone

AP Information

Accounts Payable First Name

Accounts Payable Last Name

Accounts Payable Email

Accounts Payable Title

Accounts Payable Phone

Marketing Information

Marketing Contact First Name

Marketing Contact Last Name

Marketing Contact Email

Marketing Contact Title

Marketing Contact Phone

Owner/Principle Information

Owner/Principle Name

Owner/Principle Title

References (List Up To 3)

Reference #1 Company Name

Reference #1 Account Number

Reference #1 Email

Reference #1 Phone Number

Reference #2 Company Name

Reference #2 Account Number

Reference #2 Email

Reference #2 Phone Number

Reference #3 Company Name

Reference #3 Account Number

Reference #3 Email

Reference #3 Phone Number

MAP Policy

By submitting this form, you are agreeing to the following BioLite Wholesale Terms & Conditions and MAP Policy

BioLite 2024 MAP Policy
BioLite Wholesale Terms & Conditions

BioLite updates its MAP Policy annually or more often. It is the retailer's responsibility to ensure they are working with the most current MAP Policy.

By submitting this application, the owners or business principle warrants that the information submitted in this credit application is true and correct.

The owners or business principle understands and agrees that upon being approved as a Biolite Account, it will only resell via authorized locations. BioLite will invoice dealers as orders are filled. Dealers agree to remit payment to BioLite according to their approved terms.

*Please note, BioLite does not accept credit card payments. More information on payment will be provided upon account approval

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BioLite Dealer Application

Please fill out this form for Dealer Application. For any questions please contact your sales rep or DealerServices@BioLiteEnergy.com.

Billing Information

Shipping Information

Buyer Information

AP Information

Marketing Information

Owner/Principle Information

References (List Up To 3)

MAP Policy

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