Become a Dealer | Icon Vehicle Dynamics -

Distributor Application Form

If you are interested in becoming a distributor for ICON Vehicle Dynamics, please read and fill out our online application form below in its entirety.

We also have a Printable Form: Click Here to Download the PDF. (Fax completed form to 951-689-1016)

Thank you!

Company Info
Company Name:*
Company Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone:*
Example: 9516894266 (NO SPACES)
Fax:
Federal Tax I.D.:*

Example: 95-123456
Seller Permit Number:*
Company Website Address:
Sales E-Mail Address:
Accounting E-Mail Address:
Sales Info:
What vehicles makes do you deal with the most? (i.e. Ford, Toyota, GM etc.):
How do your customers hear about you? (i.e. Word of Mouth, Online, etc.):
Do you advertise in your city? (i.e. Billboards, Signs, etc.):
Do you advertise online? (i.e. Banner Ads, Company Website etc.):
Do you have an online store?:
Do you have a showroom where you display the products you sell?:
Do you offer installation?:
Contact Info:
Owner's Name:
First Last
Accounts Payable Clerk:
First Last
List Authorized Purchasers:
In order to complete this application, a copy of your Re-Sale Card and Business License MUST be faxed in to 951-689-1016. All orders will be shipped PrePaid. For open account terms, a Credit Application must be completed and approved by the ICON Vehicle Dynamics Accounting Dept.
7929 Lincoln Ave. Riverside, CA 95204 | ph. 951.689.ICON | fx. 951.689.1016
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This information may be shared with an authorized ICON distributor, completion of this form and clicking ‘Submit’ indicates you agree to these terms.

Distributor Application Form

Company Info

Sales Info:

Contact Info: