Become a Dealer

To become a dealer please fill out and submit the online Dealer Application or you can download the PDF and email it to: sales@moonshinecamo.com or fax it to (570) 539-8604.

Thank you for considering our products and we look forward to building a relationship with your company.

Download PDF Dealer Application HERE

Dealer Application

Please Check One*
- New Application
- Renewal
Date
SECTION 1: YOUR COMPANY INFORMATION
Company Legal Name*
Do you currently sell any Moon Shine Camo Producs*
- Yes
- No
If Yes, what products?
DBA (if applicable)
Authorized Buyer and Title*
Billing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Email*
Website
Number of years In Business
SECTION 2: GENERAL INFORMATION:
Number of stores
Name of Moon Shine Camo Sales Representative
Projected Monthly Sales
How did you hear about us?
SECTION 3: REFERENCES
Reference 1: Name
Company 1
Address 1
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone 1
Email 1
Terms 1
Reference 2: Name
Company 2
Address 2
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone 2
Email 2
Reference 3: Name
Company 3
Address 3
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone 3
Email 3
Terms 3
Reference 4: Name
Company 4
Address 4
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone 4
Email 4
Reference 5: Name
Company 5
Address 5
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone 5
Email 5
SECTION 4: SOURCES
Current Channels
- Store Front
- Brick and Mortar Stor
- Shopping Mall/ Plaza
- Amazon
- Ebay
- Business Website
- Facebook
- Trade Shows
- Other
Your Web Addresses
Please List any web addresses or usernames in which we can find the products.
For all physical stores please list the address for dealer locator
Store Address 1
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

For all physical stores please list the address for our dealer locator
Store Address 2
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

For all physical stores please list the address for our dealer locator
Store Address 3
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

For all physical stores please list the address for our dealer locator
Signature
If you have any questions or concerns, please do not hesitate to contact us at: sales@moonshinecamo.com

Become a Dealer

Dealer Application

SECTION 1: YOUR COMPANY INFORMATION

SECTION 2: GENERAL INFORMATION:

SECTION 3: REFERENCES

SECTION 4: SOURCES

For all physical stores please list the address for dealer locator

SHOP ONLINE

RESOURCES

INFORMATION

ACCOUNT