Dealer Application

Date of Application

Registered Business Name

Doing Business As (Include multiple store location names)

Street Address*

Address Line 2

City*

State*

Zip Code*

Store Phone Number*

Cell Number

Website

Owner Name

Last Name

Email

Manager Name

Last Name

Email

Buyer Name

Last Name

Email

Accounting Contact

Last Name

Email

Type of Dealer

Business Structure

Number of Employees

Number of Years in Industry

Business ID Number

Resale Certificate Number

Define Your Market

Number of Retail Locations

Average Size of Store(s) in Square Feet

Do you currently purchase from either/both of Burley's distribution partners?

QBP

Trek

No

Do You Sell Online?

Yes

No

Plan To

Online Store URL

Do You Sell on Amazon or Other Marketplaces?

Yes

No

Plan To

Marketplace Account Name/s

Burley DOES NOT permit dealers to sell Burley products on eBay, auction websites or discount websites.

Annual Retail Sales Volume

Annual Online Sales Volume

Rental Business

Yes

No

Types of Rentals (Select all that apply)

Bicycles

Child Trailers

Trailercycles

Strollers

Child Seats

Other

Other Rentals

Which Bike Brands Do You Sell?

How Many Trailer Units Do You Sell Per Year?

How Many Jogging Strollers Do You Sell Per Year?

How Many Trailercycles/Trail-a-Bikes Do You Sell Per Year?

Suppliers

Supplier #1

Annual Sales (USD $)

Supplier #2

Annual Sales (USD $)

Name of Employee Submitting Application*

Last Name*

Job Title*

Digital Signature*

FILE UPLOAD:

Sales Tax Resale/Exemption Certificate
A copy of the company's signed sales tax resale/exemption certificate is required.

Supplier Invoice
Please attach an invoice from at least one supplier.

Attach File

Dealer Application

Top suggestions

Top suggestions