Dealer Application Form

4476 Dupont Ct Ste A, Ventura, CA 93003

wholesale@highflowfuel.com +1(818)574-3835

Wholesale Dealer Application

Please make sure to create a customer account on our website BEFORE completing this form by visiting this link:

Create Customer Account
Contact Name:*
Business Name:*
Website:
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email: (PLEASE NOTE: this must be the email you used to create your account)*
example@example.com
Instagram Account:
ex: @quantumfuelsystems
Facebook Account:
ex: @quantumfuel
Phone #:*
Upload Tax Exemption Certificate or Resale Certificate (REQUIRED to set your account up as Tax Exempt - a Seller's Permit alone is NOT accepted)

Browse Files

Cancelof
Certificate Expiration Date
Select the option that best describes your goal for becoming a QFS dealer:

I would like to build up my discount over time according to the volume and frequency of my orders.I would like to place an initial stocking order to receive the best discounts right away.I would like to learn more about the volume discount structure.
What industry?*

Automotive RepairAutomotive PerformancePowersportsMotorcycle/Dirt BikeMarine
Are you selling Domestically (U.S.) or Internationally? (select all that apply):*

DomesticInternational
How did you hear about our Dealer Program?*
Payment Information
We accept all forms of payment including Visa, Mastercard, Amex, ACH/Bank Wire, Paypal, and company check. Once your account has been set up you will be able to place orders directly through our website. Please email all purchase orders to wholesale@highflowfuel.com.
Agreement
1. All invoices are to be paid 3 days from the date of the invoice.

2. Claims arising from invoices must be made within 7 business days.

3. By submitting this application, I agree to receive occasional marketing emails and I understand that I may unsubscribe at any time.
Signature*

Clear
Printed Name:*
Title:*
Date:*

MonthDayYear
Date
Should be Empty:

Payment Information

Agreement