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| *Name: |
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Job Title: |
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| Company: |
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| *Address: |
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| *City: |
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*State: |
*Zip:
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| Phone: |
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Fax: |
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following questions must be answered for processing: |
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1. Please
check the box that best describes your business:
Dealer/Retailer of:
Motorcycles, Scooters, ATVs, Personal Watercraft and/or snowmobiles
Motorcycles, Scooters only dealer
ATV's only dealer
Snowmobiles only Dealer
Personal Watercraft only dealer
Service and Repair Shop
Parts and Accessories retailer
Apparel retailer
Manufacturer: please specify
Distributor: please specify
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2. Please
check the box that describes your title:
Owner, President, CEO or VP
General Manager, Store Manager
Sales Manager
Parts Manager, Service Manager
Apparel Manager, Accessories Manager
Buyer or Purchasing Manager
Other: please specify
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| 3. What is
the number of employees at this location? |
1-5
6-10 |
11-25
26-50
50 or more |
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| 4. Are you
a franchised dealer? |
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Yes
No If
yes, which brand(s)?
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*5.
What month were you born? (This is required and will
act as your electronic signature)
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| *Today's
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Date:
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