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Sly Machines 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:	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: