EmailMe Form - BimmerWorld Dealer Application

Company Name *

DBA:

Contact Name *

First Last

Owner *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Email *

Web Site *

Tax ID *

Type of Business *

Partnership

Corporation

Sole Proprietor

LLC

Years in Business

Copy of Business License

Copy Tax ID *

Copy of Reseller Certificate

Copy of Business Card

Trade References

Company *

Contact Name *

First Last

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Email *

Company *

Contact Name *

First Last

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Email *

More About You

Requested Dealer Level *

Shop/Installer

Reseller

WD

Image of your Facility *

Comments / Questions

Do you plan to -

Stock Product

Sell Online

Drop Ship

BimmerWorld Sales Associate who referred you to this form? *