Dealer Request Form

Important Note: We do not allow our products to be sold online by any dealers, nor do we drop ship to customers outside your local area. Our goal is to support our customers with local dealers who can provide representation, installation & service. Only dealers with non-ecommerce sites may display our products on their websites and only if they do not display prices.

However, there are two options for dealers who have ecommerce websites:
1) You can sell our products locally and simply not include them on your website.
2) You can join our affiliate program instead and earn commissions for all sales resulting from links to our site.

Note: all authorized Janzer dealers are allowed to participate in our affiliate program.

All Fields Required


First Name:
Last Name:
Company Name:
Job Title / Position:
Street Address:
City:
State / Province:
		If Other, please indicate here:
Zip / Postal Code:
Country:
		If Other, please indicate here:
Main Phone:
Mobile Phone:
Email:
Current or Previous Profession:

Do you currently sell mailboxes?		Yes No
If so, list the manufacturers you currently represent:

Will you offer installation services?		Yes No
If yes, specify the counties that you would like to offer installation & service within*:		*Note: you are expected to be able to provide installation & service within one week of receiving install requests.

Do you have a retail storefront showroom?		Yes No

Do you currently supply Builders or Home Owners Associations with mailboxes or other products?		Yes No
If yes, please list the other products that you supply to builders & HOA’s:

Will you be adding mailbox installation services to your existing business or services?		Yes No
If so, list the products or services that you currently offer:

If you have a website please list it here:

Additional Comments: