Legal business name: ______________________________________

Street address: ______________________________________

City/State/ZIP: ______________________________________

Province/Country: ______________________________________

Phone: _________________ FAX: _____________

E-mail: _______________________@______________

Web site: _______________________________________

Type of business: (Check) __Sole proprietor __Partnership

__Corporation __Other ________

Please provide a brief

description of your

business: _______________________________________

Name of owner: _______________________________________

Business contact: _______________________________________

Name(s) authorized to

place orders: _______________________________________

If you are an authorized OEM dealer, please list brands carried and dealer #’s: _____________________________________________________

_____________________________________________________

**Please list 3 trade references:

Company name: ______________________________________

Address: ______________________________________

City/State/ZIP: ______________________________________

Contact: ______________________________________

Company name: ______________________________________

Address: ______________________________________

City/State/ZIP: ______________________________________

Contact: ______________________________________

Company name: ______________________________________

Address: ______________________________________

City/State/ZIP: ______________________________________

Contact: ______________________________________

Please provide a copy of the following:

Yellow pages listing, newspaper or magazine ad, or other form of advertising. If this is not possible, submit a copy of your business check.

**State Resale Tax # and Federal Tax ID #____________________________________

Dirty Dawg Performance will only sell to established motor sports dealers and performance/repair shops.

We also reserve the right to refuse an application at our discretion.

At this time we are not offering open accounts, all orders will be processed by credit card.

SHIPPING:

Orders will be shipped via UPS ground. Dealer is responsible for all shipping charges. Dirty Dawg Performance will only ship direct to dealer.

MERCHANDISE RETURN POLICY:

Returns must have prior approval and authorization with RMA # before returning merchandise. Returns may not exceed 2% of your annual purchases and are subject to a 15% restocking fee.

Merchandise must be shipped prepaid and arrive in new condition.

Distributor/dealer account will be credited on all authorized returns.

I CERTIFY THAT THE ABOVE INFORMATION IS CORRECT AND TRUE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT BY SIGNING AND SUBMITTING THIS APPLICATION I AM AUTHORIZING DIRTY DAWG PERFORMANCE TO VERIFY MY STATUS WITH THE TRADE REFERENCES I HAVE PROVIDED.

**Signature of applicant:

_____________________________Date:_________________

ALL ITEMS MARKED ** ARE REQUIRED TO PROCESS YOUR APPLICATION.