Dealer Application

Complete this application to join the Simple Pump dealer network. We'll review your submission and contact you within 1-2 business days.

Application Requirements

• Valid business license and established company
• Experience in related industries (well drilling, plumbing, hardware, preparedness)
• Commitment to providing quality customer service
• Agreement to Simple Pump dealer terms and conditions

Company Information

Tell us about your business and primary contact information.

Company Name *

First Name *

Last Name *

Email Address *

Phone Number *

Company Website

Your primary company website — include the full URL (e.g., https://www.yourwebsite.com)

Other Company URL

Google Business Profile, Facebook page, etc. — include the full URL starting with https://

Mailing Address

Primary business address for correspondence and billing.

Address Line 1 * *

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Address Line 2

City *

State *

Zip Code *

Country

Shipping Address

Address for product shipments (if different from mailing address).

My shipping address is different from my mailing address

Business Details

Help us understand your business and how we can work together.

Type of Business *

Business Description *

Tell us about your company, services, and experience

Additional Information

Dealer Locator Information

We include our dealers in our online Find a Dealer tool. Please choose what information you want included if you are approved.

What information do you want in our Dealer Locator tool? *

Email Address

Phone Number

Website

Full Mailing Address

Terms and Conditions

Please review and agree to our dealer terms and conditions.

I confirm that the company applying to be a Simple Pump Dealer is a valid business and has a license to operate legally in the location specified. I have read and agree to the Simple Pump Retail Dealership Terms and Conditions. *