DEALER ACCOUNT APPLICATION & AGREEMENT ← BackThank you for your response. ✨ COMPANY (required) DBA (DOING BUSINESS AS) BILLING STREET(required) BILLING CITY(required) BILLING STATE(required) BILLING ZIP (required) SHIPPING STREET ADDRESS(required) SHIPPING CITY, STATE, ZIP CODE(required) FEIN NUMBER (FEDERAL EMPLOYER IDENTIFICATION NUMBER)(required) PURCHASING CONTACT EMAIL(required) PURCHASING TELEPHONE(required) EMPLOYEE COUNT(required) Select one option 1~5 6~10 11~20 20~50 100+ YEAR ESTABLISHED (required) ANNUAL REVENUE(required) Select one option LESS $500K $501K~1 MILLION $1.1MILLION~$2 MILLION $2.1MILLION + BUSINESS DYNAMICS(required) STORE FRONT INSTALLER WEBSTORE MARKET PLACE PLATE FORM PRIMARY MARKET FOCUS(required) TRUCK AND OFFROAD DIESEL JEEP MUSCLE EUROPEAN POWERSPORTS ELECTIC VEHICLES GENERAL REPAIR BUSINESS STRUCTURE(required) SOLE PROPRIETORSHIP PARTNERSHIP LLC CORPORATION NAME OF OWNER, FIRST AND LAST NAME(required) OWNERSHIP PERCENTAGE(required) CURRENT SUPPLIER – COMPANY 1(required) CURRENT SUPPLIER – COMPANY 2(required) TERMS AND CONDITION FIRST NAME(required) LAST NAME(required) TITLE(required) Date (YYYY-MM-DD)(required) Other Details SendSubmitting form Δ
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