You are approved as a dealer once you submit this completed form and email a scan of your business license with an authorization to charge your credit card for purchases unless you are approved for Net30 payments. You may also mail this application and/or bus. lic. to our corporate office at: CSP Imports, 3111 S. Valley View Blvd, Suite V-104, Las Vegas, NV 89102. You may purchase via phone or email to get your dealer pricing. You do not have to provide credit card or financial information if you are using your credit card or business check for individual orders. Las Vegas applicants may apply in person and receive their orders via direct courier without any delivery or shipping costs. This service will also be available in Sacremento, Reno and Salt Lake City soon.Applicant InformationDealership Name*First Name*Last Name*Password* Enter Password Confirm Password Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business InformationProducts you sellState of incorporationName of principleEIN #*Avg. annual revenue (USD)Please enter a value greater than or equal to 0.Years in businessContact InformationBusiness Phone:*Email Address:* Website Link (If applicable)Financial InformationPurchase TypePlease choose oneBusiness CheckCredit CardName on Credit CardCredit Card NumberExpiration Date MM DD YYYY Verification Code On BackCredit Card TypePlease choose oneVisaMastercardAmerican ExpressDiscoverOtherOther Credit CardAvg. monthly parts purchasing. (USD)Please enter a value greater than or equal to 0.Other InformationTells us more information that may influence our decision to approve you for your dealer application and/or Net30 account.I authorize CSP Imports to verify my credit information. I also certify that the above information is true and correct. I authorize CSP Imports to charge my credit card on file for any order shipped to the address shown above. I understand that all parts are tested before CSP Imports ships and are not responsible for installation. I understand that parts may be returned in unused conditions only, excepting electrical items which are non-refundable. The buyer is responsible for return shipping. I understand that I will receive a store credit if parts are returned within 7 days of receipt. I understand I will receive a 100% store or paid a 20% restocking fee to get a refund.* I agree PhoneThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle AJAX powered Gravity Forms.