4x4 Mods Wholesale Application Form

4x4 Mods Wholesale Application Form


If you are an established 4x4 retail store that sells aftermarket accessories in your
local area and would like to sell our products, please fill out the application below
and submit it to us. Once we have received and reviewed your application we will contact
you via email regarding access to our wholesale directory. Our wholesale site contains
special pricing lists, promotion information and special deals only available to our
wholesale accounts.

If you are looking for other wholesale information from us simply fill out the contact
information on the form below and then tell us what your questions, comments, and concerns
are in the box at the end of the form.

NOTE: - Once you have used the submit button at the bottom of this form you will automatically
be forwarded to a confirmation page. If you do not get a confirmation page, resubmit your
request or email it to us at admin@4x4mods.com

We will generally send you an email back within a 3-5 days after reviewing the
application. It is possible we made need addtional information or have addtional questions.

Name (First, MI, Last)

Title

Business Name

Business Type	Sole Prop. LLP LLC Corp Other?

Business Address	Street Street City State Zip Code

Shipping Address (If different than business)	Street Street City State Zip Code

Work Phone

Fax

Email
Website address

Do you plan to sell our items via the Internet?	Yes No
If yes, how do you market the internet?	Online store eBay Other?

Do you have a retail store, or shop?	Yes No

Please briefly decscribe your primary sales market

How long have you actively been in the trade?

Do you wish to set up a credit account?	Yes No
Business References?

Do you require and use purchase order numbers?	Yes No

How do you plan to purchase products?	Bank transfer to our Bank Account Check via mail Other?

Your requested wholesale access info:	User ID (8 char. max) Password (8 char. max) re-type password

Questions, Comments, Concerns?