COMPANY INFO

Legal Business Name*

Agent

DBA

Owner Name*

Buyer Name*

Same as the owner

Company Website*

VOT Number/Tax ID*

Address*

City*

Country*

Email*

State*

Zip*

Phone*

COMPANY PROFILE

Years on business*

What's your business model?*

Website Traffic (Monthly)*

Type of business*

Please describe other

Do you currently have a warehouse/location to store product inventory?*

Describe budget, type and frequency of your advertising and promotions:*

What are your annual sales?*

What territories/region do you cover?*

GENERAL INFO

How did you hear about AmericanElectric?*

Which AmericanElectric products are you interested in?*

Do you currently sell E-bikes?*

What other brands do you represent?*

N/A if not applicable

Please submit references that we may contact:

Business name

First Name

Phone

Last Name

Add another

SOCIAL MEDIA

Facebook

Instagram

Youtube

Twitter

Tiktok

Name*

Date*

I hereby certify that the above statements are true and correct to the best of my knowledge. I understand that a false statement may disqualify me from becoming an AmericanElectric dealer.