Thank you for your interest in becoming a Checkers Safety Group product distributor. Please note that we thoughtfully consider each application and each of our distributors is carefully selected according to a number of factors. Therefore, completion of this application does not constitute approval or acceptance as a Checkers distributor. Please tell us more about your company and market strategy by completing the following:
Corporate Address (required) *
Please complete the following information for the individual authorized to accept contractual agreements.
Name (required) *
Please tell us how you heard about Checkers or what sparked your interest in becoming a Superior distributor?
Previously Purchased from CheckersVisited the Checkers booth at a tradeshowMember of a Buying GroupManufacturer's Representative RecommendationYoutubeTrade PublicationWeb SearchEnd User Requested a Superior Product
Do you currently offer Checkers-like products? (required) *
If yes, which of the following product lines do you currently sell? (required) *
Which Checkers Safety Group brands are you interested in carrying?
Are you interested in a specific Checkers product? If so, please list item number/name below:
Please provide any additional information, comments or feedback below.