Create Dealer Account - Air Tec Innovations LLC

NEW DEALER APPLICATION FORM

$10,000 MINIMUM FIRST ORDER REQUIRED TO BECOME A AUTHORIZED DEALER

"*" indicates required fields

Full name of business*

Type of business*

Business address*

Street Address Address Line 2 City State ZIP Code

Phone*

Mobile*

Email*

This will be used as your username on this website.

Password*

Enter Password Confirm Password

Strength indicator

Create a new password for this website.

Estimated % of Turbos installed Monthly*

Estimated % of Turbos sold outright Monthly (Not Installed)*

Number of Staff*

Number of Stores*

Target Market

Public

Online

Dealers

Business

Government

What brands are you selling?*

Products you are interested in?*

Business Registration Certificate*

Accepted file types: jpg, jpeg, pdf, png, Max. file size: 3 MB.

Include a copy of your Business Registration Certificate

Picture Proof of buisiness sign, Front of buisiness / store & Shop space*

Drop files here or

Accepted file types: jpg, jpeg, pdf, png, Max. file size: 3 MB, Max. files: 5.

Name*

First Last

Position*

Signature*

Date*