MDL Dealer Application

Have you been using our products and wish to become a dealer? We can set up a program to fits your needs:

To get started we will require several of the following items as proof of the business’s existence.

Before filling out the form below make sure you have the following information handy:

Business license / Reseller’s Certificate,
The commercial address of your business,
The commercial address location on Google Maps,
A credit card that bills to that commercial address and contact info, and
Business website and/or Facebook page

Please use the link below to submit state issued automotive tax resell permit information.

Name on the permit must match the company name on file.
Follow the instructions to complete.
Once submitted, our staff will review and approve.
Some states permits do expire and must be renewed.

Cert Express

SECTION 1: COMPANY INFORMATION

Company Name: *

Company Phone: *

Company Email: *

Company Address: *

Estimated Yearly Sales: *

Business License: *

Tax Exemption Certificate: *

Use the button below to submit your state-issued tax exemption certificate via CertExpress.

Submit via CertExpress

Please note: Failure to submit your tax exemption certificate through CertExpress may result in delays in your dealer application approval.

SECTION 2: POINTS OF CONTACT

Primary Contact

Name: *

Position / Role: *

Phone: *

Email: * Same as company email

Address same as company

SECTION 3: REFERENCES (Optional)

Reference 1

Company Name:

Company Phone:

Company Email:

Company Address:

SECTION 4: ADDITIONAL SUPPORTING DOCUMENTS (Optional)

Upload any additional documents to support your application (W-9, resale certificates, etc.).

SECTION 5: AGREEMENT & SIGNATURE

By signing below, I confirm the information provided is accurate to the best of my knowledge. I understand that this application is subject to review and does not guarantee approval.

I agree to the terms and conditions of the Modern Driveline Dealer Program.

Signature: *

Date: *

Printed Name: *

Questions? Email sales@moderndriveline.com