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Become A Dealer
Fill out this form and we will contact you about becoming a dealer for Gilmore’s Off Road.
Company Legal Name
DBA Name (If Applicable)
Website
Year Business Established
Corporate Structure (Select One)
Sole Proprietorship
Partnership
Corporation
Limited Liability Corporation
Cooperative
Other
Business Address Line 1
Business Address Line 2
City
State
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Iowa
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Missouri
Minnesota
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
New York
Nevada
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Zip/Postal Code
Country
Will stocking orders ship to the business address listed above?
Yes
No
Not Applicable Drop Shipment Only
Purchasing Agent/Main Contact
Purchasing Agent/Main Contact Email
Purchasing Agent/Main Contact Phone #
Accounts Payable Information (Contact Names, Emails, Phone #)(If Different Than Purchasing Agent/Main Contact)
Marketing/Promotional (Contact Names, Emails, Phone)(If Different Than Purchasing Agent/Main Contact)
Will Your Company Stock Gilmore's Off Road Products?
Yes
No
Will Your Company Request Drop Shipment Only Of Gilmore's Off Road Products?
Yes
No
Will The Gilmore's Off Road Products Purchased Be Sold In/Used In Multiple Stores Or Facilities?
Yes
No
If You Answered Yes: How Many Locations Will Gilmore's Off Road Products Be Sold In/Used At And In Which States Or Zones?
In Which Industry Will The Product Be Used or Sold? (Select One)
Power Sports
Off Road
Racing
Other
Which Products Offered Through Gilmore's Off Road Are Interest To Your Company? Select All That Apply.
Racing
Off Road
Apparel
Tools
How Did You Hear About Gilmore's Off Road?
Current Brand Names Of Gilmore's Off Road Being Sold Within Your Organization If Applicable?
Facebook Handle
Instagram Handle
YouTube Link
Resale License #
Resale License Certificate (Required If In State Of California)
Send
