Please print this page and
fax to +1.647.723.9899
Please attach: Business Card & Government Issued Business License
We will reply by fax ASAP after receiving your application with information about your approval.
| Business Info: |
| Business Name: |
| Address: |
| City, State, Zip, Country: |
| Phone Number: |
| Fax Number (required): |
| Email Address: |
| Web Site: |
| Proprietors Info: |
| Your Name (first and last required): |
| Your Position: |
| Products Of Interest: |
| Brands Of Vehicles Targeted: |
| Please Tell Us About Your Business: |
Years In Business: |
Corporation / Partnership / Proprietorship (Circle One) |
Home Based / Garage / Warehouse / Storefront / Mall (Circle as many as apply) |
Retail / Mail-Order / Distributor / Warehouse (Circle as many as apply) |
Do you sell online and accept PayPal from your customers? YES / NO |
| Other Products Carried: |
| How would you like to sell our products: |
( ) Order in bulk and stock our products at your location ( ) Order As-Needed + samples stocked - customers see samples before buying Items are delivered to your location for customer pickup / installation ( ) Order As-Needed,
customer gets product info from print / web ( ) Order from
us as customers order from you - we ship directly to your customer |
| Please Tell Us About Your First Order: |
( ) Will Order Immediately ( ) Want to be set up for use in the future |
Estimated Order Value: Products In First Order: |
| Trade References: |
Please list three other sources you are using to buy the products you currently resell: Name 1: ______________________________________________ Phone/Web: ______________________________________________
Name 2: ______________________________________________ Phone/Web: ______________________________________________
Name 3: ______________________________________________ Phone/Web:
______________________________________________ |