To receive more information from W.R. case please fill out the form below. We will never share, sell, or rent individual personal information. Or download the Account Signup Form and fax it to 877-227-3997. Also available for download Program Level Requirements.

Company Information * Required Fields

* Contact Name:
* Company Name:
* Street Address:
* City:  * State:   * Zip:
* Phone Number:
   Fax Number:
   Email:
* Do you have a walk-in retail establishment? 
* Is this location a residence? 
* How many days is your store open? 
* Do you plan to sell Case via a website? 
* Do you plan to sell Case via internet auction (e.g. ebay)? 
Are you interested in selling Zippo lighters, too? 

Bank Reference
Bank Name:
Bank City:  State:
Phone #:

Trade References
Supplier Name:
City:
State:
Phone #:
Account Number:
Supplier Name:
City:
State:
Phone #:
Account Number: