Derby City Window Tint - Louisville, Kentucky

Fill out this form to request a dealer account with Derby City Window Tint.
After sending us this information we will email you a username and password to use at our online store. Our dealer program is for businesses only. If you are an individual please click the "online store" button to begin shopping. After clicking "submit" you may browse our site or store.

Name:
E-mail:
Company/ Organization:

Address:

City:
State:		Zip:

Phone #:	() -
Fax #:	() -
Blanket Exemption Certificate:
I hereby certify that the aforementioned company is licensed under the law(s) of the state indicated here, and that it holds the sales or use tax license or registration number indicated below, and that all tangible personal property purchased from is exempt from sales and use tax for the purpose of resale in the normal course of business.
State:
License #: