Registration

Fields with an * are required.

Profile Information

* First Name (Owner)

* Last Name (Owner)

* Business Name

Website Address

* Business Phone

Mobile Phone

* Owner Primary Email (Username/Login)

* Confirm Owner Primary Email (Username/Login)

* Password

* Confirm Password

Owner Secondary Email

Confirm Owner Secondary Email

*Business Address

* City

* State

* Zip

Payment Card Address

Please select this box if you would like your PSN Rewards card to be shipped to an address other than your Business Address.

City

State

Zip

Tax ID or Employer Identification Number (EIN)

DUNS Number

Please enter at least one of your Ford dealer or distributor invoice information below. This will allow Ford to locate you within our records and approve your registration and access to this site which will provide all your transaction history with both Ford dealers and authorized distributors, and provide you with an array of valuable tools, information, and incentives to support your business. Providing accurate invoice information that is at least 5 days old will expedite your approval.

Order/Invoice Detail 1

* Date

* Invoice Number

Order/Invoice Detail 2

Date

Invoice Number

Business Details

* How many ACTIVE service bays does your business operate?

* Please select which best describes your business, (select all that apply).
Quick Service
Brake Specialist
Tire Specialist
Full Service/General Repair
Engine/Transmission Repair
Collision Repair

* How many full-time equivalent technicians does your business employ? (2 half-time = 1 full-time)

* Do you make parts purchase decisions at your business?

* What are your average MONTHLY overall parts purchases?

Please e-mail me communications including product information, offers and incentives from Ford Motor Company and the local dealer.

* I certify that I am the owner of the Independent Repair Facility being registered.

Submission of this form acknowledges that all information provided is valid based on present knowledge and is subject to Ford Customer Service Division (FCSD) approval.