Vibrant Values — Dealer Application

Contact Information

First Name *The primary contact's first name.

Last Name *The primary contact's last name.

Email Address *Your business email. We will send application updates here.

Please enter a valid email address.

Phone Number *Select your country code, then enter your number. US/CA numbers auto-format.

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Please enter a valid phone number.

Ext.Optional phone extension if your shop uses a main line.

Job Title *Please choose the one that best describes your role.

Business Information

Shop / Business Name *Your registered business or DBA name as it appears on invoices.

Street Address *The physical address of your shop or primary business location.

Address Line 2 (optional) Suite number, unit, building, or floor if applicable.

City *City where your business is located.

State / Province *Vibrant Values is open to customers in the United States and Canada (See Terms & Conditions).

Country *Vibrant Values is open to US and Canadian dealers. International applicants are reviewed separately.

Business Tax ID *US: Federal EIN (format: 12-3456789). Canada: 9-digit Business Number. Required to verify your business.

Federal EIN (US) or Business Number (CAN). Required for approval.

Please enter a valid EIN (12-3456789) or 9-digit Business Number.

Distributor & Services

Vibrant Wholesale Distributor (WD) #1 *Who do you order Vibrant parts from most often?

Vibrant Wholesale Distributor (WD) #2 *Who else do you order Vibrant parts from?

Vibrant Wholesale Distributor (WD) #3 Anyone else? (Optional)

Social Media

Are you on Social Media? Optional. Lets us connect with you and may unlock bonus points for social engagement.

Instagram

Facebook

YouTube

TikTok

None

Other

Where can we Like, Follow & Subscribe? Share your @handles and page URLs so we can follow your shop.

Optional

How did you hear about Vibrant Values? Optional. Helps us understand how partners discover the program.