Fish Pimp Dealer Application Dealer Application If you would like to become a Fish Pimp Dealer please submit the application below. Required fields on this form are indicated with an asterisk (*). Business Name * Address * City * State * Zip * Website/URL Phone Number * Fax Contact/Buyer Name * Nickname * Email Address (This will be used as your username) * Enter Email Confirm Email Address (This will be used as your username) * Confirm Email Type of Business * Independent, Franchise, etc Store Hours * Sales Tax ID# * Date Established * Trade References * Business Certificate * Drop a file here or click to upload Choose File Maximum file size: 314.57MB Upload a copy of your Business EIN Certificate or Business License. Formats accepted: .pdf, .doc, .docx Yellow Page Listing Drop a file here or click to upload Choose File Maximum file size: 314.57MB Upload a copy of your yellow page listing if available. Formats accepted: .pdf, .doc, .docx Account Password * Create a password that will be used when logging into your dealer account. Confirm Account Password * Confirm Password reCAPTCHA If you are human, leave this field blank.
