Please fill out the following form if you are an established automotive parts or service business and are interested in purchasing Overland Parts products directly. You will recieve a username and password as soon as we verify that your business qualifies for wholesale pricing.

Personal Information:

Business Name:

Your Name/Contact:

Telephone:

Address:

City:

State:

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip/Postal Code:

Website Address:

Email Address:

Business Information:

Business Location (City/State):

How many years in business:

1 2 3 4 5 6 7 8 9 10+

How many employees:

1-5 6-10 10-20 20-50 50-100 100+

Types of cars you handle:

VW and Audi VW and Audi and Porsche Acura Alfa Romeo AMC AM General Aston Martin Asuna Auburn Audi Austin Avanti Bentley Bertone Bitter BMW Bond Borgward Bricklin Bradley Buell Bugatti Buick Cadillac Chevrolet Chrysler Citroen Checker Crosley Daewoo Daihatsu Daimler Datsun De Tomaso DeLorean DeSoto Dodge Ducati Eagle Edsel Excalibur Ferrari Fiat Ford Gazelle Geo GMC GM of Canada Graham Harley-Davidson Henry J Hillman Hino Honda Hudson Hyundai Infiniti Innocenti International Iso Isuzu Iveco Jaguar Jeep Jensen Kaiser Kawasaki Kellson Kenworth Kia Kit Cars Lada Laforza Lamborghini Lancia Land Rover Lexus Lincoln Lotus Mack Marcos Marmon Maserati Mazda Mercedes-Benz Mercury Merkur MG Mitsubishi Morgan Morris Nash Nissan Oldsmobile Packard Panoz Peugeot Plymouth Pontiac Porsche Renault Rolls-Royce Saab Saturn Scimitar Shelby American Simca Skoda Sterling Studebaker Stutz Subaru Sunbeam Suzuki Toyota Triumph TVR Vauxhall Volkswagen Volvo Willys Yamaha Yugo Zimmer

Types of parts:

All Engines Induction/Exhaust Transmission Differential/Driveline Suspension Brakes Controls Electrical

If you provide service, how many lifts do you operate?:

1 2 3 4 5+

How many cars do you service per month?:

50 50-100 100-200 200-500 500+ 10-50

Have you purchased from Overland Parts before?:

No Yes

Have you worked with any Overland Parts products before?:

No Yes

If so, what product and when?:

None Engines Induction/Exhaust Transmission Differential/Driveline Suspension Brakes Controls Electrical     None Less Than a Month Less Than Six Months Less Than a Year Over a Year Over Three Years

Have you spoken with an Overland Parts salesperson?:

No Yes

If so, who and when?:

Please describe the products you are interested in:

Questions or Comments: