If you are interested in becoming an international PerTronix dealer, please complete the form below.

Fields marked * are required. (U.S. dealer opportunities >)

*Your Name:
*Your Title:
Company Name:
*Address:
*City:
State:
*Postal Code:
*Country:	Select... Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Azores Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Bosnia Botswana Brazil Brunei Bulgaria Burkino Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Chad Channel Islands Chile Colombia Commonwealth of Indian St Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Czechoslovakia Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faeroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kampuchea Kazakhstan Kenya Kiribati Kosrae Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Madeira Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Mynamar Nambia Nauru Nepal Netherlands Netherlands Antilles Nevis New Caledonia New Zealand Nicaragua Niger Nigeria Norfolk Islands Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peoples Republic of China Peru Philippines Poland Ponape Portugal Puerto Rico Qatar Republic of Ireland Republic of Yemen Reunion Romania Rota Russia Rwanda Saba Saipan San Marino Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka St Christopher St Croix St John St Martin St Thomas St. Barthelemy St. Eustatius St. Kitts & Nevis St. Lucia St. Maarten St. Vincent and the Grena Sudan Suriname Swaziland Sweden Switzerland Syria Tahiti Taiwan Tajikistan Tanzania Thailand Tinian Togo Tonga Tortola Trinidad Truk Tunisia Turkey Turkmenistan Turks & Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu New Hebrides Venezuela Vietnam Virgin Islands Wake Island Wales Wallis and Futuna Islands Western Samoa Yap Yugoslavia Zaire Zambia Zimbabwe
*Phone:
Fax:
*Email:
Web Site:

What type of business are you?	Garage/Repair ShopRetail Store Import/ExportSales Agency Internet SalesWarehouse Distributor DealerOther (please specify) Manufacturer
If other, please specify:
What countries do you do business in?	(For multiple selections, hold down the CTRL key and select) Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Azores Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Bosnia Botswana Brazil Brunei Bulgaria Burkino Faso Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Chad Channel Islands Chile Colombia Commonwealth of Indian St Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Czechoslovakia Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faeroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kampuchea Kazakhstan Kenya Kiribati Kosrae Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Madeira Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Mynamar Nambia Nauru Nepal Netherlands Netherlands Antilles Nevis New Caledonia New Zealand Nicaragua Niger Nigeria Norfolk Islands Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peoples Republic of China Peru Philippines Poland Ponape Portugal Puerto Rico Qatar Republic of Ireland Republic of Yemen Reunion Romania Rota Russia Rwanda Saba Saipan San Marino Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Korea Spain Sri Lanka St Christopher St Croix St John St Martin St Thomas St. Barthelemy St. Eustatius St. Kitts & Nevis St. Lucia St. Maarten St. Vincent and the Grena Sudan Suriname Swaziland Sweden Switzerland Syria Tahiti Taiwan Tajikistan Tanzania Thailand Tinian Togo Tonga Tortola Trinidad Truk Tunisia Turkey Turkmenistan Turks & Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu New Hebrides Venezuela Vietnam Virgin Islands Wake Island Wales Wallis and Futuna Islands Western Samoa Yap Yugoslavia Zaire Zambia Zimbabwe Other (Please specify below)
If other, please specify:
What market do you serve?	AgriculturalMarine AutomotiveOther (please specify) Industrial
If other, please specify:
What product lines are you interested in?	Ignition ProductsThunderbird Exhaust Products Patriot Exhaust Products
Anticipated yearly volume?	Select... 50-100 units 100-500 units 500-1000 units 1000-5000 units 5000 or more units
What other ignition or exhaust manufacturers do you carry?	AccelJacobs CompufireMallory CraneMSD FlowtechThorley HedmanOther (please specify) Hooker
If other, please specify:
What information can we send to you?	Ignition CatalogIgnition Brochure Patriot Exhaust CatalogLocal Warehouse Distributors Thunderbird CatalogBuy in Requirements
Any other comments?

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