Dealer Status Request

Request Form

Thank you for your interest in becoming a Day 6 Outdoors authorized dealer. Please complete and submit the form below. We will review your request and contact you soon.

Fields marked with * are required.

Log In Information
E-mail*
Confirm E-mail*
Password*
Confirm Password*
Business Information
Company*
Primary Contact First Name*
Primary Contact Last Name*
Phone*
Fax
Store Type*
Number of Stores*
Day 6 Outdoors Products*
Website (Do not include http://)
Display in Dealer Listing?*
Federal Tax ID*
Georgia Tax ID
Billing Address
Billing First Name*
Billing Last Name*
Address*
Address 2
City*
State*
Zip/Postal Code*
Country*
Shipping Address    Shipping information same as billing.
Shipping First Name*
Shipping Last Name*
Company*
Address*
Address 2
City*
State*
Zip/Postal Code*
Country*
Shipping Location Phone
Terms of Service
Dealer Agreement
I agree to the Dealer Terms of Service*
Are you human?* Please enter in the letters and/or numbers you see to the right.*