Kamakazi ATV - DEALER APPLICATION

Email Address:

Password:

First Name:

Last Name:

Business Name:

Address Line 1:

Address Line 2:

City:

State:

Zip Code:

Phone Number:

Fax Number:

Website address: (www.companyname.com)

Principle Owner:

How Long In Business:

How Many Employees:

Do you have a service bay: Yes No

What is your principle business at this time:

Do You currently sell scooters or ATVs: Yes No

If YES which brands:

If the dealer or fleet sales price is acceptable, what is your monthly projection of units sold: