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32700 Capitol Street
Livonia, MI 48150, U.S.A.
Tel:(734)542-1500
Fax:(734)542-7095
Email:office@leapers.com



Dealer Application Form
   
Welcome to join the Leapers' Dealer Group!

Please fill out the application form, attach your business/sales license to the form and click on Submit. You can also print this form, fill it out and fax it together with your business/sales license to Leapers at 734-542-7095.

A sales representative will contact you either via email, phone call, or fax. Once your dealer account is established, your log in User Name and Password will be provided to you. They can be used to place orders on the website. There is a minimum order amount of US$300 for each US dealer order, and US$3,000 for each international order. Order processing will be handled offline. (Additional international requirement may apply depending on country and products.)
Field(s) marked with * is required.
*Company Name:
Company Website
*First Name:
Middle Initial:
*Last Name:
*Office Phone No.:
Mobile Phone No.:
Fax:
*Email:
*Region:United StatesInternational
 Billing Address:Shipping Address:
 Same as Billing Address
*Street
*City
State/
Province
*Country
*Zip Code
Years in Business:
Tax ID:
Business Operations:
(e.g. store, Trade Show)
Include with Your Application a Copy of Your Business License and any other documents you deem appropriate.
In regions where a business license is not available, please provide documentation certifying that you are a business operating legally within your area.
Attach Business License:  
Attach Document 1:  
Attach Document 2:  
Product Focus
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32700 Capitol Street, Livonia, MI 48150, U.S.A.
Tel:(734)542-1500 Fax:(734)542-7095 Email:office@leapers.com
© 2009 - Leapers, Inc. All Rights Reserved