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DEALER APPLICATION



 
Legal Company Name:   Date:
Doing Business As:
Street Address:
City:
    State:      Zip:
Phone #: Fax #:
Email Address:
Website Address:
Billing Address:
Federal ID#:
Resale #:

Type Of Ownership (Check One):
  

Name Of ...

         
Home Address:

City:

State:
  Zip:   
Home Phone #:

Social Security #:

Driver's License #:

Name Of ...

         
Home Address:

City:

State:
  Zip:   
Home Phone #:

Social Security #:

Driver's License #:

Store Manager:


 Accessory Manager:
Parts Manager:


 Book Keeper:
Description/Type Of Business:
Motorcycle:            


Franchise Dealer For:
               

            

Store Hours: Monday-Friday: From To Saturday:  From  To

Date Business Started:

Is A Purchase Order Required With Each Order?
   
 
Do You Sell Mail Order Or Via Internet?
   

 
Requested Method Of Payment:

 TRADE REFFERENCES
1.Company Name:

City:

State: Zip: 
Phone #:

Fax #:
2.Company Name:

City:

State: Zip:
Phone #:
Fax #:

3.Company  Name:

City:

State: Zip:
Phone #:

Fax #:
4.Company  Name:

City:
State: Zip:
Phone #:

Fax #:

    I Hereby Affirm That All Of The Above Information Is Correct
Print Name:
Date:

Signature:

enter the numbers in the box to the left (required)