Registration - Partner Application

Partner Application Form

Please complete the form below. We will review the application and send an email upon completion. This form is for retailers that currently sell Black Cat. If you are a retailer looking to sell Black Cat or are new to the business, please click here.

Basic Information
Name*
First Last
Username*
Email*
Password*
Enter Password Confirm Password

Strength indicator
Company Information
Company Name*
Your Title
Mailing Address*
Street Address City State / Province / Region ZIP / Postal Code
Business Phone*
Cell Phone
Business Fax
Retailer Information
Number of Retail Locations?*
Approximate number of Black Cat items carried?*
Approx. number of all fireworks items carried?*
What year did you start selling fireworks? (ex: 1990)*
Type of Partner (Check all that apply)
- Retailer
- Wholesaler
- Importer
Additional Info
Primary Black Cat Suppliers
Supplier 1
Company*
Location*
Contact Name*
Phone*
Email*
Supplier 2
Company
Location
Contact Name
Phone
Email

Partner Application Form

Basic Information

Company Information

Retailer Information

Primary Black Cat Suppliers

Supplier 1

Supplier 2

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