Apex Dealer Application

Apex Dealer Application
DomesticInternational
Silver : Requires 2 sets / 8 wheel buy-inGold : Requires 5 sets / 20 wheel buy-inPremier : Requires 25 sets / 100 wheel buy-in
Gold : Requires 5 sets / 20 wheel buy-inPremier : Requires 25 sets / 100 wheel buy-in
Please list the wheels desired to satisfy buy-in:*
BMWMustangHondaCorvettePorscheCamaroVW / AudiSubaruToyotaOther
Business Information
Business Name*
DBA
Sole ProprietershipPartnershipLLCS CorpC Corp
State Corporation Filed In*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Format: (000) 000-0000.
Email*
Website
Start Year of Business*
Federal EIN #*
State Tax ID #
Business License #*
General Service and MaintenancePerformance ServiceFabricationTire ShopE-CommerceRetail StorefrontAuto Dealership
Principal / Owner / Office Information
#1 - Principal/Owner/Officer Name*
Title*
% of Ownership*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Format: (000) 000-0000.
Email*
#2 - Principal/Owner/Officer Name
Title
% of Ownership
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number
Format: (000) 000-0000.
Email
Accounts Payable
A / P Contact Name*
A / P Phone Number*
Format: (000) 000-0000.
A / P Email*
Additional Authorized Contacts / Purchasers
#1 Authorized Contact Name
#1 Authorized Contact Phone Number
Format: (000) 000-0000.
#1 Authorized Contact Email
#2 Authorized Contact Name
#2 Authorized Contact Phone Number
Format: (000) 000-0000.
#2 Authorized Contact Email
Attach a copy of valid Business License*

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Attach a recent interior photo of your business*

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Please verify that you are human*
Should be Empty:

Apex Dealer Application

Business Information

Principal / Owner / Office Information

Accounts Payable

Additional Authorized Contacts / Purchasers