1. CONTACT INFORMATION FIRST NAME LAST NAME Contact Name: Email Address: * Phone Number: * 2. STORE INFORMATION Store Name: * What type of store front do you sell automotive aftermarket products from? Retail Only Online Only Retail and Online WEBSITE URL: (IF ANY) http://www. RETAIL LOCATION Store Address: City: State: Select State Alabama Alaska Arizona Arkansas California CANADA CANADA Colorado Connecticuit 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 Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming American Samoa Zip: 3. SELECT YOUR REGION: Select the region of your primary place of business. NORTH-RG1: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin WEST-RG2: Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming CANADA-RG2: British Columbia, Alberta, Saskatchewan EAST-RG4: Alabama, Connecticut, Delaware, Florida, Georgia, Kentucky, Maine, Maryland, Massachusetts, Mississippi, New Hampshire, New Jersey, New York, North Carolina, Pennsylvania, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, West Virginia CANADA-RG4: Manitoba, Ontario, Quebec, New Brunswick, Newfoundland, Nova Scotia SOUTH-RG5: Arkansas, Louisiana, Oklahoma, Texas 4. WHY WESTIN? Why do you want to sell Westin? Reputation Product Design Warranty Brand Loyalty Customer Requests Product Line Promotions/Discounts Ease of Installation Customer Service Price Availability Please add any comments or questions you may have: