Welcome Agents and Dealers!

AutoXcel offers some of the highest value products in the automotive industry....

ORDER CONTRACTS HERE

To become and Agent with AutoXcel please fill out the Agent Information Signup Form here.

To offer AutoXcel products at your dealership please fill out the Dealer Information Signup Form here.

 


 



 


Agent Information Signup Form

 
 
 

 

Asterisk (*) denotes required field

*Agency name:                               EIN#:              

*Physical Address:                       *City:               

*State:                                              *ZIP Code:      

Mailing Address (if different)

Office phone #:                          Office Fax #:       

*Email:                                          

________________________________________________________________________________________________

Principal

Agency Principal:        Phone #:           Email:  

Office Controller:         Phone #:           Email:  

________________________________________________________________________________________________

Additional Members

Agency Member:             Title:           

Phone:                              Email:  

 

Agency Member:             Title:           

Phone:                              Email:  

 

Agency Member:             Title:           

Phone:                              Email:  

 

Agency Member:             Title:           

Phone:                              Email:  

 

Agency Member:             Title:           

Phone:                              Email:  

 

Agency Member:             Title:           

Phone:                              Email:  

 

 
 

 


Dealer Information Signup Form

 
 
 

 

Asterisk (*) denotes required field

*Legal name:                                Group name:        

*Email:                                           *Dealership DBA:

*Physical Address:                      *City:                     

*State:                                             *ZIP Code:            

Mailing Address (if different)

Dealer Principal:

Controller:           

Office Manager: 

Phone Number:  

Fax Number:       

Tax ID Number:  

_____________________________________________________________________________________________

*Name and Title of Person Signing Agreements:

General Manager :  

Sales Manager:       

F&I Director:             

Service Manager:   

Programming:         

Finance Manager:        Finance Manager Email:

Finance Manager:        Finance Manager Email:

Finance Manager:        Finance Manager Email:

Finance Manager:        Finance Manager Email:

Website Address (if available):

Dealer DMS (i.e. – ADP/CDK, Reynolds, Arkona, other) :
_____________________________________________________________________________________________

Primary Contact Person

Agency:                  Phone:

Dealership:            Phone:

Please send agreements to: Agent   
                                                      Dealership


 

Please send supplies to:        Agent
                                                      Dealership
                                               

 

 

 

 

 

If sending to a dealer please submit the following:

Name:     

Address:


Phone:
  

   

________________________________________________________________________________

Check All Products That Apply:

StayNu

Dynamic Wheel

Dynamic Wheel Max

Dynamic Wheel Max Exotics

Dynamic Glass

AX3

AX4

 

AX4 with Key

Dynamic Image

Certainty GAP

Zone Blue

RecoverKey

Lease Wear & Tear

AutoXcel PDR

Other:

 

________________________________________________________________________________

*Effective Date:         Installation Date:           

Rep/Agent:               

 
 


   
 

Vin Decoder

Order Contracts

Full Products Catalog

Marketing Materials Order form

Agent Information Signup Form

Dealer Information Signup Form

Product Cancellation Form


Remit Forms

REMIT Form - StayNu

REMIT Form - Dynamic Glass

REMIT Form - Dynamic Wheel

REMIT Form - Dynamic Wheel MAX

REMIT Form - Dynamic Wheel MAX Exotics

REMIT Form - Dynamic Image

REMIT Form - Dynamic Image Interior Only

REMIT Form - Dynamic Image RV

REMIT Form - Certainty GAP

REMIT Form - AX3

REMIT Form - AX4

REMIT Form - AX4 with KEY

REMIT Form - RecoverKey

REMIT Form - Zone Blue

REMIT Form - AutoXcel PDR