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Dealer Application
Business Name
*
Doing business on behalf of
Buyer or Primary Contact
*
Title
First Name
Last Name
*
Email
Business Phone
Website
*
Social Media
*
Years In Business
*
Number of Locations
States Where You Operate/Sell
*
Federal EIN
*
Shipping Address
Country
Street
City
State/Province
Zip/Postal Code
Billing Address
Country
Street
City
State/Province
Zip/Postal Code
Define your Type of Business
Select an option
Agriculture
Apparel
Banking
Biotechnology
Chemicals
Communications
Construction
Consulting
Dealer
Education
Electronics
Energy
Engineering
Entertainment
Environmental
Finance
Food & Beverage
Government
Healthcare
Hospitality
Insurance
Machinery
Manufacturing
Media
Not For Profit
Other
Recreation
Retail
Shipping
Technology
Telecommunications
Transportation
Utilities
Physical Retail Location Details
Do you operate an online store?
Do you sell on Amazon, eBay, Walmart Marketplace or other marketplaces?
If yes, please list the marketplaces
Which BRCC Product are you interested in carrying?
BRCC Energy
Ground Coffee
Merchandise/Apparel
Ready to Drink Coffee
Seasonal/LTO
Single Serve
Whole Bean
Do you currently sell coffee?
Which Coffee Brands do you currently carry?
Do you currently sell energy drinks?
Which Energy Brands do you currently carry?
Lead Source
Select an option
Advertisement
Customer Event
Employee Referral
External Referral
Google AdWords
Other
Partner
Purchased List
Trade Show
Webinar
Website
MobileApp
Sales Rep Name
Distributor Name
Were you referred by someone? If so, please provide their name.
Tell us about your customer base and why BRCC is a good fit for your business
How is your business different than others in your industry?
Dealer Agreement & Policy Acknowledgements
Initial Minimum Order: $1,500
*
Order Minimum Purchase: $750
*
Annual Minimum Purchase: $5,000
*
Dealer agrees to follow BRCC MAP pricing policy
*
Dealer agrees not to resell on unauthorized third-party marketplaces
*
Dealer agrees to represent the BRCC Brand Appropriately
*
I certify that the information provided is accurate and complete. Submission of this application does not guarantee approval. BRCC reserves the right to approve or deny any application.
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