Dealer Registration Form

Authorized Dealer Application
Please provide details below to qualify your business with us. If your company qualifies to become a dealer, we will be in contact with you to provide any needs you may have. Thank you for your interest in Price Designs!
Business Owner*

First NameLast Name
Business Name*
Contact Number*

Area CodePhone Number
E-mail*
Company Website*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Business Tax ID/EIN
Type of Business*
How long have you been in business?*
Please list the products that you service/sell.*
Please provide a short description about your company.*
How did you hear about Price Designs?:*
Please describe your current interest level in becoming a Price Designs Dealer.*

Looking to start in 6 monthsReady to buy today
What market do you service? What is your geographic region?*
What is your annual sales volume?*
How do you acquire new customers?*
Estimate how many custom sets of wheels you would sell per year:*
Should be Empty:

Authorized Dealer Application