Dealer Portal Access Form

Dealer Portal Access Form

Ma' Cline's Coffee, (MCC) a division of Cline Manriquez Brands (CMB) produces and markets high quality food products that produce results if consumed in proper amounts consistently. CMB maintains very high ethical standards and expects the same from all affiliates and dealers, especially with regard to product health claims and customer service.

We do business through dealers utilizing a revocable license which may be revoked at any time at CMB's sole discretion.

Not every application will be approved, however we endeavor to answer every application within a few days. Thank you for your interest.

Legal Business Name (if any)
Doing business as dba
Business Address Business Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Contact Person Name Contact Person Name * First Last
Title
Phone Phone * - ### - ### ####
Email *
Alternate Contact Person Name Alternate Contact Person Name First Last
Title
Email
Marketing Method. Check all that apply.

Marketing Method. Check all that apply. Business to Consumer Business to Dealer Network Business to Business Business to Non-profits Personal Use/Research Other Other
Annual Sales $ (USD)

Annual Sales $ (USD) <$50,000 $50,000-250,000 $250,000-1,000,000 >$1,000,000 Other Other
Upload Business License(s)

Attach Files
Upload a photo of business

Attach Files
Upload a wholesale tax certificate

Attach Files
How you found us? *
Person who recommended you?
Draw your signature into the box below. *

Clear
Title of Authorized Signer *
Date Date / MM / DD YYYY
By checking I agree that I have read and will abide by Terms and Conditions

https://b2b.maclinescoffee.com/terms.php *

By checking I agree that I have read and will abide by Terms and Conditions

https://b2b.maclinescoffee.com/terms.php I agree