Dealers click the picture below to order your Surevalve ™ stock online
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Become a Surevalve ™ dealer , get special dealer pricing on Surevalve ™, Accessories, and access to HCW Services' Inc. Online Dealer Ordering Site. Apply today. Minimal purchase required to sign up, less than $100. Email us at dealers@hcwsinc.com with any questions.
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HCW Services Inc. Surevalve ™ Dealer Application Form
By applying to become a Surevalve ™ dealer through HCW Services Inc. your company or you agree to resell Surevalves ™ to retail customers at a minimum of $24.95 or more, and agree to exclusively purchase your stock of Surevalves ™ from HCW Services Inc. at the current dealer rates.
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Company Name
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HCW Services Inc. Sales
Rep. |
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First Name
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Address |
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Last Name |
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City
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Phone # |
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State
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Alt Phone # |
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Postal Code
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Fax # |
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E-mail
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| Tax Information |
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Federal Tax ID |
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Expiration
(mm/dd/yyyy) |
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*Note if you live in Florida and do not have a Florida sales tax ID you will be charged 7% sales tax.
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Florida Sales Tax ID |
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Expiration
(mm/dd/yyyy) |
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If you do not own a business or don't have a Federal Tax ID please complete below.
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Social Security |
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Signature |
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Drivers license |
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Position (if a company) |
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All items marked (*) are required.
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| REMINDER |
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To complete the Registration process.
Email or mail this form and a copy of your Tax ID Certificate and Florida state tax ID (if applicable).
or
Email or mail this form and a copy of your drivers license showing your current address.
HCW Services Inc.
PO Box 1395
Englewood, FL 34295
Email your questions to dealers@hcwsinc.com
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