Automatic Distributors Form -

Become a Dealer

The information listed below must be completed and returned to us as soon as possible so that we may establish your account. Please understand that this application applies to becoming an active wholesale customer. If you wish to have an open credit line with us and to avoid COD shipments a credit application must be filled out and approved.

Company Name(Required)

Sales Tax#(Required)

Years in business

Company Address(Required)

Street Address City State ZIP Code

Shipping Address (if different)

Street Address City State ZIP Code

Company Phone(Required)

Company Fax

General Email(Required)

Purchasing Contact Name

Phone

Purchasing Email

A/P Contact Name

Phone

A/P Email

Type of business(Required)

Sole Proprietorship

Partnership

Corporation

Purchase order required?(Required)

Yes

Do you have backorders?(Required)

Yes

Please check all that applies to what best describes your business. Is your business:(Required)

Dealership

Parts House

Repair Shop

Internet

Please check all that applies to what best describes your business. We sell/repair:(Required)

ATV/UTV

Dirt Bikes

Jet Skis

Motorcycles

Snowmobiles

Trailers

Brands Sold(Required)

Please name two trade suppliers with whom you currently have a purchase history(Required)

I certify that I have read the above statements and all information provided is accurate

Legal Company Name(Required)

Digital Signature(Required)

Date(Required)

MM slash DD slash YYYY

Name of Authorized Signature(Required)

Name Title

This field is for validation purposes and should be left unchanged.

autodist.com

(207) 942-6769

[email protected]

Facebook Linkedin