New Account Request

Get started with Dorfin today!

If you do not have an account with Dorfin and would like to have a sales representative call on you, please complete the New Account Request Form below and one of our sales team will contact you as soon as possible.

Or contact us by phone and we will be glad to assist you.

Company *

Number of Employees at location * 1-4 5-9 10-49 50-99 100-999 1000+

Type of Business (Retailer/Distributor) * Distributor Distributor Electronic/High Tech Distributor Industrial Distributor Sanitation Distributor MRO Exporter Government /School/Hospital Manufacturer Manufacturer Food Manufacturer Industrial Products Retail Retail Big Box Retail Fashion Retail Discount /Dollar Retail Hardware Retail Pharmacy Retail Grocery Retail Department Other (Please specify below)

If 'Other', please specify:

Website

Full Name *

Job Title

Address 1 *

Address 2

City *

Province/State *

Postal Code/Zip Code *

Phone Number *

Fax Number

Email Address *

Do business your preferred ways. Check all of the ways of communication that are acceptable to you Sales Rep Visit
Telephone
Email
Fax

Check your preferred ordering methods Sales Rep Visit
Telephone
Email
Fax
Online

Comments or Questions

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