Warranty & Marketing Registration Application

Select Rewards members agree to provide marketing information including vehicle ownership and warranty registration that may qualify for incentive. Rewards members that receive incentive may be liable for any federal, state or local taxes. Select Rewards members may opt-out at any time by contacting Rachel Batty: rbatty@douglasdynamics.com.

Step 1 of 2

Cardholder Information:
Name*
Full Legal First Name MI Full Legal Last Name
Legal Home Address*
Street Address City State / Province / Region ZIP / Postal Code
Legal Mailing Address (If Different)
Street Address City State / Province / Region ZIP / Postal Code
Home Phone*
Cell Phone
Email*
Date of Birth*
Month
Day
Year
Social Security or Taxpayer ID*

Warranty & Marketing Registration Application

Step 1 of 2

Cardholder Information:

Dealership Information:

Need more help? Contact a Dejana Sales Rep.