1-760-296-3590 . 1-877-751-4357

Retail Tax ID #

(please fax a copy of your retail sales license to 1-760-296-1309)
Name of the Owner (s)
Company Name
Billing Address
Shipping Address
Email address
Website url
Is your business any of the following:
Retailer Manufacturer End User Service Business Wholesaler
Authorized Personel to make purchase on behalf of your company
Name / Title
Name / Title
Name / Title
Wholesale customers must use our wholesale pictures (located at to promote and sell our products.
It is illegal to use other sites retail images so please use only the images from
Payment: Visa/ Master Card, Discover or AMEX
Roddickgear will beat any competitors listed prices at any time.
Proof of lower pricing is required, please contact customer service at 1-877-751-4357 for more information.
This information is warranted to be true and correct and is given for the purpose of setting up wholesale account with
Your Name / Title / Date
Type the image* 

(this step prevents automated programs from submitting this form)