Pirate Lab Dealer Sign-up
Thank you so much for your interest in Pirate Lab. Before you sign up, please make sure to read all our Terms and Conditions and MAP policy. By signing up to become a dealer, you are agreeing to abide by all our dealer policies. https://piratelab.com/pages/interested-in-becoming-a-pirate-lab-dealer

Please fill out the form below. We will get back to you within one business day. Our business hours are M-F 9am-5pm CT.

Email address *
Preferred Contact Name (First and Last) *
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Preferred Contact Phone Number *
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Store Name *
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Tax ID# *
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Shipping Address (Street Address, City, State, Zip, Country) *
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Optional: How did you hear about us? (Choose all that apply)
Optional: Product interest (Choose all that apply)
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