EmailMe Form - Custom Dynamics Domestic Dealer Application

Custom Dynamics Domestic Dealer Application

Thank you for your interest in Custom Dynamics!

TO AVOID DELAYS, Be sure to complete the entire Application and Attach the Following (USA Dealers Only):

1. Proof of general shop liability insurance policy with $1M minimum general liability coverage
2. Resale Tax Exemption Certificate for state to which you will ship parts
3. Dealer Application

Please be aware that our dealer program is limited to brick and mortar retail shops, resellers and garages in the motorcycle and/or automotive/offroad industry.

If you have any questions while completing this application please reach out to us at erin@customdynamics.com or 919-554-0949.

Legal Business Name *
Primary Contact *
First Last
Billing Contact
First Last
Email *
Additonal Email
Phone *
### - ### - ####
Phone Extension
Web Site
Social Media Links
Shipping Address *

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

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
What type of business are you? *
OEM Motorcycle Dealer
OEM UTV Dealer
Online Retailer
Used Bike Reseller
Service Shop
Manufacturer
Other

Please Select all Units your business services

	YES If Selected
Harley-Davidson
Indian
Metric Motorcycles (Honda, Kawasaki, Yamaha, Suzuki, Polaris/Can Am)
Offroad - UTV, ATV, SXS & Golf Carts
E Bikes
Automotive
Other - Please note in Additional Comments Section

Comments/Other - Provide Brief Description of your Business and/or the aftermarket electronics (LEDs, modules, etc.) you're currently using.
Please include any additional information or questions about your business here.
Estimated Annual Spend on Motorcycle Lighting and Electrical Accessories *
$0 - $5k
$5k - $10k
$10k - $50k
$50k - $100k
$100k +
Why are you interested in becoming a Custom Dynamics dealer? *
Are you a DRAG Specialties or Parts Unlimited Dealer? *
If Yes, provide your DRAG Specialties or Parts Unlimited Account Number and the name of your Representative.
Resale Tax Exemption Certificate for state to which you will ship parts (see below). *
Accepted Resale Tax Exemption Certificates
Review Accepted Resale Tax Exemption Certificates via hyperlink included, above.
Custom Dynamics Advertising Policy *

I have reviewed the Custom Dynamics Advertising Policy and I have read and understand the Advertising Policy requirements.
Name *
First Last
Date Time
MM / DD / YYYY