Distributors

All potential dealers and partners must fill out the application below. Provide as much information as possible.

Company Name*
Address*
Street Address City State ZIP Code
Phone*
Fax
Email*
Website
How did you hear about Gardner-Westcott?
Owner or President Name
Purchasing Contact Name
Describe business or organization*
Type of business & profile (check all that apply)*
- Franchising Shop
- Servising Area
- Customizing Shop
- Purchase Orders Required
- Back Orders Allowed
Type of bikes worked with
What other companies are you a dealer / retailer for?
Business type*
Federal Tax ID #*
Are you subject to sales tax?*
You answered "No" above. Enter your tax exemption number*
Preferred payment method*

For Online Orders: Email sales@gardner-westcott.com | Call (800) 897-5025 | Fax (800) 871-5110