Untitled Document

Klotz Warehouse Synthetic Lubricants

Mailing only: P.O. Box 236 Charlotte Hall MD 20622

Phone: (443) 852-5191

Klotz Warehouse Dealer Pre-Approval Form

Please complete and return along with ALL of the following:

A	Directory Listing (If a track vendor, please provide photo of your sales vehicle at track.)
B	Copy of your Business License or Tax ID Certificate
C	Invoices from a present supplier in the racing industry **When approved, orders will be shipped Visa, Mastercard, American Express, payment in advance by money order cashier’s check and Direct Deposit. New Dealer terms and pricing will be emailed upon approval of dealer application.

(*)Required Field

Off Road/On Road Power sports

RC Model

V-Twin/ Street Motorcycles

Automotive Sprint Kart Drag etc..

Trade References 1 (must be in Racing/High Performance Industry or related field) Business Name Address Phone

Trade References 2

Accounts/Payable Person Phone Number

*Company Name

*Owner Name

*Address

*City

*State

*Zip

*Years in Business

Shipping Address if Different

City

State

Zip

*Phone Number

*E-mail

Website

Attach Files Click Browse Button and down load your file(s)

		Directory Listing (If a track vendor, please provide photo of your sales vehicle at track.)
		Copy of your Business License or Tax ID Certificate
		other image files (store pic etc..)

Business Name Address Phone Contact Name Terms

I certify that the above information is true. By signing this application, I agree to resell Klotz Warehouse products, at a reasonable market price to all customers that Klotz Warehouse may refer to my business. Check here

I would like a call back: ( Yes ) (No )

Questions or other Comments