Dealer Application

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Please fill out the following Dealer Application form. For security reasons, please call or fax us your credit card info.

General Company Information

Contact Information

Organization Information

References Please list names and phone numbers of three Trade References (Parts or Tucker or WPS accounts if available):

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.