Your Information

First Name *

Last Name *

Phone Number * With area code. Ex: 715-555-5555

Email Address * Will be used to log into your Badger Truck account. Must not already be used.

Password * Minimum 8 characters (numbers, letters, symbols)

Confirm Password * Same password as above. This is done to prevent accidental typos.

Tax Exempt? * Yes No
Are you applying for tax exempt status? Verification will be required.

Upload Verification:

Address Information

Company Name

Company Website

Address *

City *

State * —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zip Code *