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Performance Carbon Dealer Account Registration
If your company is a sales organization affiliated with the automotive parts industry and you would like to be an authorized
Sly
Machines 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:
Choose a State
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carloina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
or
Zip:
*(5 digits)
-
Country:
Choose Country
United States
Canada
Mexico
Telephone:
(
)
-
Ext.
Fax:
(
)
-
Email:
Website Address:
SHIP To
Same as BILL To
We
cannot
ship to PO Box addresses.
Address:
Suite:
City:
State:
Choose a State
Alaska
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
District of Columbia
Delaware
Florida
Georgia
Hawaii
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carloina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
or
Zip:
*(5 digits)
-
Telephone:
(
)
-
Ext.
Fax:
(
)
-
Country:
Choose Country
United States
Canada
Mexico
6 - 20 characters
Combine numeric AND alphanumeric
Password:
Password Again:
Proof of California Resale Number Required
California
Resale Number: