BECOME A DEALER

Dealer Application

"*" indicates required fields

Legal Business Name*

DBA

Email*

Phone*

Website URL*

Address*

Street Address Address Line 2 City State ZIP Code

Shipping Address

Same as above

Business Name*

Attention*

Address*

Street Address Address Line 2 City State ZIP Code

Billing Information

Contact Name*

Contact Phone*

Email for Invoicing*

State Resale # or Taxpayer ID*

Notice To Buyer: By signing below on behalf of your business, you represent that your business is a valid business entity; that all purchases made on this account will for purposes other than personal, family or household use; and that you are an authorized representative of the business with authority to enter into contractual agreements. On behalf of the business, you certify that all information provided in this application is complete and accurate and you agree to be bound by the terms of the Credit Agreement.

Signature*

Printed Name*

Title*

Date*

Gianna Wheels is committed to protecting your privacy. By clicking 'submit,' you consent to us using your information to contact you about Gianna Wheels. For more details, please read our privacy policy.

Company

This field is for validation purposes and should be left unchanged.