A&R Italian Imports Registration

Please complete form below in all fields in order to become an authorized dealer. Also note that you need to send us also a copy of your Tax Certificate or other proof that you are a legal business. Allow 1-2 business days to have your request reviewed for approval. We thank you in advance for the becoming a A&R Italian Imports dealer.

General Info

*Name

*Last Name

*Email

*Username Please use only a-z,A-Z,0-9,dash and underscores, minimum 5 characters

*Password Minimum 8 characters

Business Information

*Company

*Business

*Tax Certificate Number / EIN

*Phone

Fax

*Website (http:// is required.):

Billing Address

*Address

*City

*Zip/Post Code

*State/Province

*Country

Shipping Address

Name

Last Name

*Address

*City

*Zip/Post Code

*State/Province

*Country

I agree to the terms and conditions as set out by A & R Italian Imports and commit that I am a registered vendor/retailer.