DEALERS
Already one of our dealers? Click here!
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Else, you can fill out the Dealer Application below. A PDF version is also available.

After you've submitted this form, you'll be taken to a printer-friendly page with all your information typed out. Print that page, sign it and send it to us by fax at the following number: 514.493.0630.

Thanks! We're looking forward to doing business with you!
Company name: Email:

Website:
DBA:
Address:
City:
Province: Phone:
Postal code: Fax:
Delivery address:
Federal tax no.
Provincial tax no.
Date of foundation of company
Owners and Partners
Name and address of owner and partner
Name:
Title:
Phone:
S.I.N. #:
Address:
City:
Province:
Zip Code:
Name:
Title:
Phone:
S.I.N. #:
Address:
City:
Province:
Zip Code:
Name of person authorized to place an order at Splash'n Dirt!
Name:
Title:
Name:
Title:
Name:
Title:
Brand of motorcycle/ATV authorized by the manufacture to sell, (Ex: Honda, Yamaha, etc)
1:
2:
3:
4:
Main supplier of parts and accessories:
Volume of annual sale of parts and accessories:
Volume of annual sales:
Show room surface for parts (SQ.FT.):
I'm interested to offer:
DMC
Douglas Wheel
AC Racing
LoneStar Racing
Hinson
Durablue
Maier
Magura
Magnum
Outerwears
OMF
Nac's
Pro-Design Ross Piston RP Racing
SDR Bearing Carrier SDR Cam Shaft
SDR Lock Nut Shift Pro Shockwears
Sit On It Sniper Racing Exhaust
SS Performance Terry Cable UPP
Web Cam Other
Supplier’s reference (Motorcycle manufacture, supply other than motorcycle parts supplier)
Please put the names and address of your 3 main suppliers with whom you have an open account.
Supplier #1:
Name:
Phone:
Fax:
Address:
Supplier #2:
Name:
Phone:
Fax:
Address:
Supplier #3:
Name:
Phone:
Fax:
Address:
Supplier’s reference
(Trade motorcycle parts supplier)
Please put the names and address of your 3 main suppliers with whom you have an open account.
Supplier #1:
Name:
Phone:
Fax:
Address:
Supplier #2:
Name:
Phone:
Fax:
Address:
Supplier #3:
Name:
Phone:
Fax:
Address:
Bank information
(Due to Internet security, please print out your account number yourself, i.e. with a pen)
Name of the bank:
Address:
Account number:

____________________________________
Phone:
Fax:
Mode of payment
(Due to Internet security, please print out your credit card number yourself, i.e. with a pen)
COD Credit card
(Visa or Mastercard)
Type of card:
Card number:

____________________________________
Expiration date:
Name on the card:
Address where the statement of that credit goes:
Name of the person in charge of the accounting:
Signature:

___________________________________________
24 % of interest per year (2% per month) will be applied on every unpaid or overdue balance. Every bought item will remain a property of Splash'n Dirt Accessories. They can not be mortgaged or given by guarantee until the total payment of the applicant with Splash'n Dirt Accessories. In the case of the failing of the payments, Splash'n Dirt Accessories will have the right to take back all merchandises of equivalent value of the amount due.

Do not print this page — use the Submit button to reach the printer-friendly page.
© 2006 Splash'n Dirt
185C Jules-Léger, Boucherville (Quebec) CANADA J4B 7K8 Phone: 450.449.4442