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Dealer Account Registration

If your company is a sales organization affiliated with the automotive parts industry, or an authorized Jeep dealer and you would like to be an authorized Team Sly reseller, please complete and submit the following information:

	Items in bold are required.

	Contact Information
Dealer / Organization:
Department:
Title / Position:
First Name:
Last Name:
	BILL To Enter the address on the statement that is associated with the credit card that will be used later when your orders are placed.
Address:
Suite:
City:
State:	or
Zip:	*(5 digits) -
Country:
Telephone:	() - Ext.
Fax:	() -
Email:
Website Address:

	SHIP To
	Same as BILL To
	We cannot ship to PO Box addresses.
Address:
Suite:
City:
State:	or
Zip:	*(5 digits) -
Telephone:	() - Ext.
Fax:	() -
Country:

	• 6 - 20 characters • Combine numeric AND alphanumeric
Password:
Password Again:
	Proof of California Resale Number Required
California Resale Number: