Dealer Registration

We’re excited for you interest in becoming an official Dominator dealer! We look forward to working with you to help you grow your business with our fantastic line of products.

Please a take moment to fill out the form below so we can start the on-boarding process

If you have any questions, please don’t hesitate to call (801) 768-4663.

Sales Contact Information

Primary/Sales Contact Name(Required)

Primary/Sales Contact Phone(Required)

Primary/Sales Email(Required)

Billing Contact Information

Billing Contact Name

If Different From Primary

Billing Contact Phone

If Different From Primary

Billing Email

If Different From Primary

Billing Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Shipping Information

Shipping Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Professional References

List

Name

Telephone

Relationship

Payments

All manual checks for payment of invoices to be sent to:
Leap Innovations
405 N 880 W, Suite C
Lindon, UT 84042
Invoices are due within agreed-upon terms shown on the invoice. A late payment fee of 5% per month may be charged on all outstanding balances.

Name(Required)

Date(Required)

New Dealer Registration