Wholesale Parts Customer Account Application

Application form for fleet, body shop, and independent repair-shop wholesale accounts, including business details, tax exemption status, credit terms request, and pricing tier assignment.

Application Type

• Account Type
• Request credit terms?
• Are you claiming tax exemption?
• Additional notes
  Use this field only for information needed to process the application. Do not include sensitive personal data unless it is necessary for account setup.

Business Information

• Legal Business Name
• DBA / Trade Name
• Business Phone
• Business Email
• Business Website
• Years in Business

Business Address and Contacts

• Business Address
  Include street, city, state/province, and postal code.
• Primary Contact Name
• Primary Contact Title
• Primary Contact Phone
• Primary Contact Email

Account and Credit Details

• Estimated Monthly Parts Spend
  Approximate monthly wholesale parts spend used for account review and pricing tier assignment.
• Preferred Payment Method
• Requested Credit Limit
• Credit References
  Provide only the references needed to evaluate the account. Avoid including unnecessary personal data.

Tax Exemption and Compliance

• Tax Exemption Type
• Certificate Number
• Supporting Document
  Upload a resale certificate or other exemption document if available.
• I certify that the tax exemption information provided is accurate and applies to eligible purchases only.

Pricing Tier and Authorization

• Requested Pricing Tier
• Pricing Tier Justification
  Explain any special pricing considerations, volume commitments, or contract terms.
• I acknowledge that account approval, credit terms, tax exemption status, and pricing tier assignment are subject to review and verification.
• Authorized Signature
• Signature Date