Kookscustomerheader.com - Dealer Application

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Kooks Custom Headers is actively looking for new dealers and distributors. All dealers must have a legitimate retail location, and will be required to submit copies of business license and resale permit. Please answer all questions and click Submit. If you have an immediate need and have a customer waiting for product, please call 866-586-KOOK

- We are interested in becoming : ------------------------------------------------------------------------------------------

Stocking Wholesale Distributor Dealers:

Jobber Dealer:

Other:

- Business Information: --------------------------------------------------------------------------------------------------------

Business Name:
Phone:
Fax:
Street Address:
City:
State:
Zip Code:

- Contact Information: ---------------------------------------------------------------------------------------------------------

Contact Name:
Title/Position:
Years In Business:
800# or 2nd Phone:
# of Locations:
Annual Sales:
2nd Address:
Size (sq.ft.):
Email Address:
Website:
Additional Info:

- How did you become aware of Kooks Headers and Exhaust Products: ----------------------------------------

Retail Customer Inquiries:	Trade/Car Show:
Magazine:	Television:
Other:

- Your Primary Source of Business is: --------------------------------------------------------------------------------------

Localized Retail Sales:	Wholesale:
Internet:	MailOrder:
Other:

- Your Primary Business Focus is: --------------------------------------------------------------------------------------

Race Shop:	Passenger/Sports Car:
Truck/SUV:	Full Line Warehouse Distributor:
Street Rods/Restoration:	Other:

- Do you currently have an account with a wholesale distributor?: -----------------------------------------------

Yes we have a current account with:

Please list 3 Business References:

- Business Reference 1: --------------------------------------------------------------------------------------------------------

Business Name:
Phone:
Fax:
Address:
City:
State
Zip
Years Working With:
Products Purchased:
Terms

- Business Reference 2: --------------------------------------------------------------------------------------------------------

Business Name:
Phone:
Fax:
Address:
City:
State
Zip
Years Working With:
Products Purchased:
Terms

- Business Reference 3: --------------------------------------------------------------------------------------------------------

Business Name:
Phone:
Fax:
Address:
City:
State
Zip
Years Working With:
Products Purchased:
Terms

- Do you advertise in any publications: -----------------------------------------------------------------------------------

Yes we advertise:

Please List the publications you advertise in:

- Do you publish your own catalog: ---------------------------------------------------------------------------------------

Yes we publish a catalog:

- What kind of exhaust products do you currently sell: --------------------------------------------------------------

Current Exhaust Carried: