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3M
Distributor Application
*
Indicates Required Fields
Business
Legal Business Name
*
Company name listed on purchase order(if different than the legal business name)
Address
Street Address
*
City
*
State
*
- Select A State -
Alaska
Alabama
Arkansas
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District of Columbia
Delaware
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Nebraska
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New Mexico
Nevada
New York
Ohio
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Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Zip
*
Phone
Please enter numbers only, no characters.
*
Fax
Please enter numbers only, no characters.
Owner’s Name
*
Additional Contact Name
Billing
Billing Location
Check if same as above
Business Name
*
Contact Name
*
Address
*
PO Box
City
*
State
*
- Select A State -
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Zip
*
Phone
Please enter numbers only, no characters.
*
Fax
Please enter numbers only, no characters.
Email
Accounts Payable Email Address. All invoices and statements will be sent to this address.
*
Contact Email Address
Company Information
ASI#
PPAI#
Dun and Bradstreet#
Types of Business (Please check all that apply)
Single Location
Franchise
Branch Office
Advertising Agency
Other
What primary industries do you service? (Please check all that apply)
Healthcare
Insurance
Financial
Education
Automotive
Retail
Manufacturing
Non-Profit
Real Estate
Service
Other
What tools do you utilize to market products? (Please check all that apply)
Catalog
Product flyers
Samples
Email
Sales force
Store front
Enter your email address below to join our exclusive group of distributors receiving our promotional email and updates.
Communications will be sent by 3M Promotional Markets located at:
2020 Lookout Drive North Mankato, MN 56003.
You can opt out of these emails at anytime by clicking the opt out link at the bottom of our emails or contacting us to remove you from the list.
Exemption
Check if
not
exempt from sales tax
You will be charged appropriate sales tax on all orders.
I, the undersigned purchaser, hereby certify that all of the above information pertaining to my business is correct.
*
Digital Signature of Authorized Purchaser
*
I have read and understand that completing and submitting the application does not guarantee approval to become a 3M Promotional Markets Distributor Powered by CCA Occasions Distributor. I understand that I will be notified by email if my application is approved and I will receive an account number at that time.
*
Notes
Signature of Purchaser
*
Title of Authorized Purchaser
*
Date
*
Please enter a valid phone number, numbers only, no characters.
Please enter a valid billing phone number, numbers only, no characters.
Please enter a valid fax number, numbers only, no characters.
Please enter a valid billing fax number, numbers only, no characters.
Email is not formatted correctly.
Contact email is not formatted correctly.
Promotional email is not formatted correctly.
Please check the box to indicate that the above information is correct.
Please check the box to indicate that the products are exempt.
Please check the box to digitally sign this document.