Authorized Dealer Program Registration Form

*Required Fields

Physical Address
* Dealer Name: 
* Contact Name: 
* Address: 
Address2: 

* City: 
* State: 

* Zip: 
* Phone: 

Country: 
Fax: 

* Email: 
Website address : 

Mailing Address
Same as Physical address
Company Name: 
Address: 
Address2: 

City: 
State: 

Zip: 

Country: 
Do you currently have a display unit.   Yes  No
If yes, Who did you receive the Display Unit from: 

If yes, What display unit(s) do you currently have: 
   Lo Pro Qt   Original Truxedo   Truxport   Deuce   Harley Davidson
If no, Would you like us to send you a Display Unit at no charge:  Yes  No
Where did you first hear of TruXedo: 
How long have you sold TruXedo Accessories: 
Do you stock TruXedo:  Yes No
Do you sell TruXedo online:  Yes No
Do you sell any other tonneau covers:  Yes No
If so, what brands: 
Would you like to receive our email newsletters :  Yes No
Would you like to order your Display Units now : Yes No

 
 
Contact Us About Us Buy Now Dealer Locator Home Gallery Become a Dealer Order Display Units