Dealer Application Form
Dealer Information
Business Name
Representative Name
Business Address
Suburb
State
Post Code
Store Contact Number
Alternative Contact Number
Email Address
Website
About Your Business
Please tell us about your business by filling out the fields below:
Type of Business
Online
Retail
Online & Retail
Wholesale
Rewards
Other
How long have you been in business?
< 1 year
1-5 years
6-10 years
11-15 years
16-20 years
20+ years
How many locations?
Which brands are you interest in?
(Please make your selection)
Lifespan Fitness
Cortex
Lifespan Kids
Reebok Fitness
Backyard Discovery
XDS Bicycles
Icon
Rocky Mountain
Jamis Bikes
Eastern
What interested you about our brands?