Dealers Online Form

Vantage Ag's Retailer Form

Join our trusted dealer network and help bring innovative crop solutions to growers across the region.

Official name of business/company

Owner

Company Email

Company Phone Number

Billing Information

Main contact person

Main contact email for invoices

Who to cc on invoice emails

Mailing address (include postal code)

Phone Number

Shipping Information

Main contact person

Main contact email for transportation documents

Who to cc on transporation document emails

Physical shipping address

* Physical shipping address (for Transportation company). Please include postcode*

Google coordinates (if neccesary)

Phone Numbers: (for trucker to contact location)

*If you have additional shipping locations beyond the ones listed above, please email the full details to ayesha.n@vantage.ag after completing and submitting this form. Include all information for each new location as you did above.*

Additional Information/Contacts to Be Added to Account

*Please list any other individuals who should be included on the account (e.g., for orders, billing, or general communication)*

Name

Phone Number

Name

Phone Number

Additional Information/Delivery Instructions & Directions

* Please include any important details for delivery, such as gate codes, loading dock info, preferred delivery hours, or directions to the location.*

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.