Reseller Registration

Attention Resellers: The following questions are for New and Exisiting resellers of New and Rebuilt, Clutch Kits and Accessories.

1. We would like to establish you a Potential Reseller Customer in our database. Please enter the information requested.

   Company Name

   
   

   Company Address

   City

   State

   Zip Code

   Country

2. What is your First Name ?
   
   
   
   
3. What is your Last Name ?
   
   
   
4. What is your email address
   
   
   
5. What is the Primary Function of this company ?
   
   
   
6. Does the Company hold Active Membership to a Specialty Organization for increased sales potentials (I.E. SEMA, IPAA, CORE)
   Yes No
   
   
7. How Many Employees do you have?
   
   None 1-2 3-4 4-8 8 or more Employees

1. Do you have Purchasing Powers within your company
   
   Yes No
   
   
2. Are you able to Supply to Clutch Specialties Financial information with regards to Terms and Conditions for Credit?
   Yes No
   
   
3. Do you Support End User Customers with Repairs or Upgrades In-House?
   
   Yes No
   
   
4. How Many Repair/Upgrade technicians do you currently have
   
   0 1-2 3-4 5 or more
   
5. How Many Estimated Packages do you ship From Your Dock Daily ? (I.E. UPS,FedEx, Airborne, etc)
   
   0 1-5 5-10 10-20 20 or more
   
6. Please Select the subject areas you are most interested in:
   
   Domestic Automotive clutches
   Import Automotive clutches
   Domestic Truck clutches
   Import Truck clutches
   Performance Oriented clutches
   Heavy Truck clutches
   Industrial Equipment clutches
   Special Application clutches
   
7. Would you accept E-Mail from Clutch Specialties, with regards to New Products, Current Products, Pricing, Credit Terms and Conditions for approval.
   Yes No
   
   

THATS IT!

Thank you for taking the time to answer the questions in our survey.

We assure you any and ALL information you have submitted to us will be kept for OUR USE ONLY. We Like our Customers and we will Strive to Protect our professional interests.

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