Name

Company Name

Email Address

Phone

Business Address

Address Line 2

City

State / Province / Region

Zip

Country

Please Note: If you answer NO to all questions, your application will be rejected Please Note: If you answer NO to all questions, your application will be rejected

Do you want to be a "service only" retailer? * Do you want to be a "service only" retailer? * Service Only (Yes) Sales & Service (No)

Do you have a showroom? * Do you have a showroom? * Yes No

Has your company done business with EV RIDER in the past? * Has your company done business with EV RIDER in the past? * Yes No

Are you exclusively an online internet dealer? * Are you exclusively an online internet dealer? * Yes - I only sell online No - I also have a storefront where people can buy in person

Do you need to sell products online with dropship? * Do you need to sell products online with dropship? * Yes No

Message - Anything Else We Should Know?