Dealer Application Form
Company Name
Street
City
State / Province
Country
Postal Code / Zip
Contact Name
Email
Telephone
Fax
Cellphone (optional)
Website (optional)
Business No. (optional)
PST / HST No. (optional)
Business Structure
- Please Select -
Corporation
Partnership
Sole Proprietor
No. Years in Business
Annual Sales (USD)
- Please Select -
less then $500 k
$500 k - 1 Million
$1 Million - $5 Million
more then $5 Million
Number of Employees
- Please Select -
less then 5
5 - 10
10 -50
more then 50
Business Type
- Please Select -
Retail Store
Car Dealership
Internet Store Only
Internet with Store Front
How did you find us
Breify describe your company
(target market, geographic customer base, products offered, best selling products etc)
Back to Distributor
© 2010 Visual Garage Inc. All Rights Reserved.