"Hand Off"

New Dealer / Distributor Setup Form

ESI (Extreme Steering Inc) PO Box 294147 | Phelan, CA 92329

Contact us by Phone: (760) 947-4345 Email: extremesteering@prodigy.net

Are you are a dealer or distributor and would like to offer our products to your customers?

Please feel free to request a dealer or distributor account by filling in the form fields below.

A representative from ESI will contact you to complete your request.

For a complete list of authorized ESI distributors go to Distributors.

Please provide the following information:

Company Name
DBA (Doing Business As)
Is your company a	Distributor or Dealer

Web Site
Phone		Fax

Contact Name		Position
E-mail

SHIPPING information:
Street Address
City
State
or Province
Zip/Postal Code
Country

BILLING information if different:
Street Address
City
State
or Province
Zip/Postal Code
Country

Please enter at least one of the following.
State Resale Certificate :
Business License :
Tax ID/Federal ID :
VAT :

Terms and Conditions of Sale

  Net 30 Terms
  If you are granted payment terms, you agree that if you are late paying your invoice, a 1.5% finance charge or the maximum charge permitted by law may be assessed against all accounts with past due balances. You agree to pay all the company's reasonable attorney's fees and all collection agency fees incurred in the collection of any amount owed there under and not paid when due.
  Acceptance
  Your submittal of an online order and/or phone Order and/or email Order is a conditional acceptance by ESI of your offer to purchase our goods and your acceptance of our terms and conditions. Your receipt and retention of the goods covered by this invoice shall constitute acceptance of these terms. You and ESI agree that any contract hereby entered into has been made and is to be construed to California Law.

Check Returns
Check returned for insufficient Funds will be assess a $50.00 fee.

If you wish to order Online

Please provide your ESIgrips.com account information:

User Name

Password

Confirm Password

How did you learn about ESIgrips.com?

I have read the terms above and agree to the conditions stated.

Please enter your name as your online signature:

Date

Position

ESI's way of saying Thank You

FREE stickers (2) with each grip purchased!

FREE shipping with purchase of 3 or more grips!

Terms and Conditions for Free shipping: US only! Global orders will receive a DISCOUNT.

Invoice will be manually adjusted prior to shipping. - Shipping charges show when you order -

Free shipping not available with Coupon or Dealer Orders!

Made In The USA

SSL encryption is used to secure our shopping cart!

ESI is Extreme Steering Inc | ESIgrips.com | ESIracing.com | www.ExtremeSteering.com