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New New or Used Motorcycle Parts - Dealer Application

Dealer Application

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

Type Of Ownership:
*

Owner Information:
Name Of ...
Home Address:
City:
State:
Zip:
Home Phone #:

Owner Information
Name Of ...
Home Address:
City:
State:
Zip:
Home Phone #:

Company Information
*Store Manager:
Accessory Manager:
Parts Manager:
Book Keeper:
Description/Type Of Business:
Motorcycle: V- twin    Metric    ATV    Snowmobile
Accessory Store Repair Shop Exporter Other - Explain:
Franchise Dealer For: Harley-Davidson    Honda    Kawasaki    Suzuki    Yamaha    BMW    Ducati    Arctic Cat    Polaris    Other
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:
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