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Dealer Application
Dealer Application
Please fill out the following Dealer Application form. For security reasons, please call or fax us your credit card info.
General Company Information
Business Name*
Business Address*
City*
State
Select State
Outside US
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Country if not US
Zip*
Contact Information
Email*
Phone Number*
Fax Number
Contact Person*
Title*
Organization Information
Operating as*
Proprietorship
Partnership
Corporation
LLC
Number of years in business*
Federal Tax ID Number*
State Retail License Number*
References
Please list names and phone numbers of three Trade References (Parts or Tucker or WPS accounts if available):
1)
2)
3)
Supporting Documents
Please email the following documents to us at
[email protected]
:
Proof of Business - Copies of your Federal Tax ID, Business License, State Tax ID or Sellers Permit
Photocopies of advertising or business cards.
Proof of location - Photos of your retail shop or kiosk
The more supporting documentation you provide, the faster we can process your dealer application.
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