DownLoad Dealer Application
DEALER APPLICATION
Legal Company Name:
Date:
Doing Business As (D.B.A):
Street Address:
City:
State:
Zip:
Phone #:
Fax #:
Email Address:
WebSite Address:
Billing Address, If Different:
Federal ID #:
Resale #:
Type Of Ownership (Check One):
Individual
Partnership
Corporation
LLC
Name Of ...
Owner
Partner
Officer
Home Address:
City:
State:
Zip:
Home Phone #:
Social Security #:
Driver's License #:
Name Of ...
Owner
Partner
Officer
Home Address:
City:
State:
Zip:
Home Phone #:
Social Security #:
Driver's License #:
Written Change Of Name & Ownership Is Required
Store Manager:
Accessory Manager:
Parts Manager:
Book Keeper:
Description/Type Of Business:
Motor Cycle:
V- twin
Metric
ATV
Snow Mobile
Accessory Store
Repair Shop
Exporter
Other - Explain:
Franchise Dealer For:
Hardly-Davidson
Honda
Kawasaki
Suzuki
Yamaha
BMW
Ducati
Arctic Cat
Polaris
Other
Store Hours: Monday to Friday:
to
Saturday:
to
Date Business Started:
Is A Purchase Order Required With Each Order?
Yes
No
Do You Sell Mail Order Or Via Internet?
Yes
No
Requested Method Of Payment:
COD/Company Check
Credit Card
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: