EmailMe Form - Dealer Form

What is Dealer Status?

Dealer Status is a discount program available to motorsports related businesses that have a Tax ID and EIN number.

Or

A current customer with parts purchase history of at least $5,000 USD within the last year to date.

Business & Contact Information

Business Name:

Owner:

First Middle Last

Billing Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

* If you will need your orders shipped somewhere else other than the "Billing Address," please provide details in the "Special Request" box below.

Business License Number:

Tax Identification Number:

Number of employees:

Business Type (resale, repair):

Primary Phone Number:

### - ### - ####

Fax Number:

### - ### - ####

Email Address:

Web Address:

Questions to Best Assist You

How Did You Hear About Our Dealer Program?

What Brand of Parts Do You Purchase Most?

What Is Most Important To You When Purchasing Parts (pricing, speed, accuracy)?

Do You Have Any Special Requests?

• Once application is submitted, we will review purchase history and business information. Ordering Instructions and Level placement will be emailed to you upon Dealer Status review.

• All businesses must provide scan of License and Tax ID form.

• If in Michigan, complete Michigan Tax ID form 3372.

License Scan

Tax ID Form(*MI Only)

• Please contact adehn@partspitstop.com for any issues or questions pertaining to the dealer form.

* If misuse of dealer program is evident in any way, Parts Pit Stop reserves the right to revoke dealer status at any time based on discretion.

Customer Signature: *

Clear

Date: *

MM / DD / YYYY