Customer Profile Sheet

Please fill out this form in its entirety so we can better set up a program for your success.

Company Name *

Website *

Date *

Representative

Billing Address *

Shipping Address *

Phone *

Fax Number *

Business Contacts

Please enter the following information pertaining to contacts within your company.

Owner

Owner Name *

Owner Email *

Owner Phone *

Purchasing Manager

Purchasing Manager Name *

Purchasing Manager Email *

Purchasing Manager Phone *

Accounting

Accounting Name *

Accounting Phone *

Advertising

Advertising Name *

Advertising Email *

Advertising Phone *

Sales Information

Please enter the following information pertaining to sales and brand information.

Annual Sales *

First Year Projected Sales *

Are you part of a buying group? *

If Yes, Name of Buying Group

Are Your Currently Buying JY Power? *

If Yes, Name of Current Supplier

Are We Replacing A Competitors' Line? *

If Yes, Name of Competitor

What Competitive Lines Do You Currently Carry? *

Markets Serviced

Please check all markets that you currently service.

Choose All That Apply *

Race
Audio
Marine
Powersports
Commercial
Emergency
Military
Off Road
Other

Online Dealer

Please fill out all information below if you intent to sell online.

Choose All Marketplaces Your Sell On Currently *

Website
eBay
Amazon
Walmart
Facebook/Instagram
TikTok
Off Road
None
Other

Are Your Interested In Placing Your Orders Through The Website? *

Yes
No
Other

Additional Comments

Thanks for your interest!

We appreciate you contacting us. One of our account managers will get back in touch with you soon!

Have a great day!

Thanks for considering JY Power. We'll review your application and get back to you with any questions.

Thanks for your interest!

We appreciate you contacting us. One of our account managers will get back in touch with you soon!

Have a great day!

Contact information

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