Dealer Request Form

We are always looking for self motivated, energetic and enthusiastic individuals to join our TEAM! If you would like more information on how to become a dealer for The Liberty Dock Company, we invite you to fill out this simple form. After your submission you will be contacted by the owner of The Liberty Dock Company. Thank you for your interest, and we look forward to having you on our team!

This Form cannot be submitted until the missing fields (labelled below in red) have been filled in
Request Information to become a Liberty Dock Authorized Dealer
First Name*
Last Name*
E-mail Address*
Street Address*
City*
State/Prov*
Zip/Postal Code*
Country*
Dealer For Docks or Boat Lifts*	Docks Boat Lifts Both
What other companies do you represent now?
Do you belong to a buying group?
Do you sell over the internet?	Yes No Website under construction
Do you have a store front?	Yes No I have other space available to me
How long have you been in business?	Less than 5 years More than 5 years Retired
Do you have knowledge in the Boat Dock or Boat Lift Industry?	Yes No Some
How did you hear about us?	Internet Referral Other Means
Please enter the word that you see below.

The Liberty Dock Company
23837 State Hwy 39
Shell Knob, MO 65747
Office: 866-375-1190
"DOCK RESPONSIBLY"

SBI!

Dealer Request Form

Request Information to become a Liberty Dock Authorized Dealer