NetGain Motors, Inc.
Authorized Motor Dealer Application
U.S.A. applicants must include copies of business license and resale tax certificate
FAX TO: 630-685-4054 or EMAIL TO: ngm@go-ev.com


There are prerequisies that must be met before we will consider an application for a Authorized Motor Dealer. Check the boxes below indicating you have met the prerequisite:


YES NO






Company Name*
Contact First Name* Contact Last Name*
Steet Address 1 Street Address 2
City State
Zip Code Web Site URL
Country
Telephone Number Alternate Telephone Number
Fax Number
Email* Alternate Email
Enter a Login Name Enter a Password
Federal Tax ID Number State Resale Tax Number
Select Type of Business
President or Owner's Name
President or Owner's Address
President or Owner's Home Telephone

Enter Applicable Information About Your Company and EV Experience

  
By clicking "Submit", the Applicant certifies that all information on this form is true and accurate to the best of their knowledge.

 

To request further information you may CLICK HERE, or to purchase a motor, please contact one of our Authorized Dealers or  Authorized Distributors.

You may contact us directly via the following:

NetGain Motors, Inc.
800 South State Street, Suite 4
Lockport, Illinois 60441
Voice: 630-243-9100
Fax: 630-685-4054

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