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DEALER APPLICATION

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					                            DEALER APPLICATION


COMPANY NAME

ADDRESS

CITY ______________________________________ STATE ______________ ZIP _____________

BUSINESS LICENSE #                             NATURE OF BUSINESS

TAX PERMIT #                                   CORPORATION? YES          NO

BUS. PHONE (      )                            BUS. FAX (       )

OWNER’S NAME

OWNER’S ADDRESS

OWNER’S PHONE (       )                        YEAR BUSINESS STARTED

BUSINESS HOURS

PERSONS AUTH. TO PLACE ORDERS



CURRENT SUPPLIERS OF MOTORCYCLE PARTS:




FOR OFFICE USE ONLY: _____________________________________________________________




                       1554 LINDA WAY • SPARKS, NV • 89431
                      PHONE: 775-359-4450 • FAX: 775-359-5149

				
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