Become a Dealer

Distributor Application Form

If you are interested in becoming a distributor for ICON Vehicle Dynamics, please read and fill out our online application form below in its entirety.

We also have a Printable Form...Click Here to Download the PDF. (Fax Completed form to 951-689-1016)

Thank you!

Company Information
Company Name*
Company Address*
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Phone*
Example: 9516894266 (NO SPACES)
Fax
Federal Tax I.D.*
Example: 95-123456
Seller Permit Number*
Company Website Address
Sales E-Mail Address
Accounting E-Mail Address
Sales Information
What vehicles makes do you deal with the most? (i.e. Ford, Toyota, GM etc.)
How do your customers hear about you? (i.e. Word of Mouth, Online, etc.)
Do you advertise in your city? (i.e. Billboards, Signs, etc.)
Do you advertise online? (i.e. Banner Ads, Company Website etc.)
Do you have an online store?
Do you have a showroom where you display the products you sell?
Do you offer installation?
Contact Information
Owner's Name
FirstLast
Accounts Payable Clerk
FirstLast
List Authorized Purchasers
In order to complete this application, a copy of your Re-Sale Card and Business License MUST be faxed in to 951-689-1016. All orders will be shipped PrePaid. For open account terms, a Credit Application must be completed and approved by the ICON Vehicle Dynamics Accounting Dept.
7929 Lincoln Ave. Riverside, CA 95204 | ph. 951.689.ICON | fx. 951.689.1016
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Become a Dealer

Distributor Application Form

Company Information

Sales Information

Contact Information