Wholesale Account Application Request

To set up a wholesale account with Bumper Blocker, please follow these instructions:

Please complete the following dealer / wholesale request form to be contacted by someone in our wholesale division. Only businesses with automotive affiliation shall be considered!

In order to become an authorized reseller of the Bumper Blocker we require proof of business: i.e. Resale Certificate, Tax I.D., City Permit, City License, and/or any other pertinent information such as copy of advertisement, business card, etc.

Your Name:

Your Company:

Your Address:

Your City:

Your State:

Your Zip Code:

Your Telephone:

Your E-mail:

Subject:

Message:

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