Xpress Batteries Application

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Application Forms

Business(Required)

Program(Required)

ProgramReason(Required)

Do you have existing premises?

Yes

No

CurrentPremises(Required)

IdentifiedPremises(Required)

AverageBatteryVolumes(Required)

Funding(Required)

Have you done a competitor analysis for the identified area?

Yes

No

MajorCompetitors(Required)

Do you have an active account with AutoX?(Required)

Yes

No

AutoXAccountNumber

What is your perceived loyalty to AutoX through your current battery purchases?

Industry(Required)

Personal Information

First Name *(Required)

Last Name *(Required)

Company Name(Required)

Email *(Required)