Fields marked with an *Asterisk are required unless your country does not have states or provinces.


*Company Name/Name:
DBA(Doing Business As):
*Primary Contact Person:
*How would you like to purchase products?  Distributor   Direct
Would you like to be a custom tuning dealer?  Yes
*Already selling SCT/Bully Dog products?  No  Yes
I purchase SCT/Bully Dog products from:
*Address Type:
*Address 1:
Address 2:
*Zip/Postal Code:
*Email Address:


 Billing Address same as above:
*Billing Address Type:
*Billing Country:
*Billing Address 1:
Billing Address 2:
*Billing City:
*Billing State/Province:
*Billing Zip/Postal Code:
*Billing Phone#


*Do you have a Dyno?:
*Do you have a storefront?:
*Tax ID #:
*State/Province of Registration:
*Website, if multiple separate by comma:

Please verify you are human.

*Not Case-Sensitive*

Please allow up to 24 business hours for approval. If approved, you will receive an Authorized Reseller Agreement to review and sign electronically via DocuSign. Contact with any questions.