Thank you for requesting our dealer application, and for supporting an American Manufacturer.  We look forward to an excellent business relationship.  Lazy Rider only sells direct on the Internet, but not in our dealer's town or city.  For this reason we need the following information to help us qualify your business as a legitimate motorcycle business.  Our definition of legitimate:

Date: ______________________

 

Company Name: ______________________________________________________________________

 

Shipping Address: _____________________________________________________________________

 

City: ______________________________ State: ___________________ Zip: _________________

 

Business Hours:_______________________________________________________________________

 

Optional: Email address: _______________________________________________________________

 

Web Site URL:  _______________________________________________________________________

 

Bus. Phone: (            ) _________/_____________        Bus. Fax: (             ) _________/_____________

 

Owner(s) name (Print): _________________________________________________________________

 

Home Phone: (            ) _________/_____________

 

Names of persons authorized to purchase on account: _______________________________________

 

_____________________________________________________________________________________

 

Main Contact person: __________________________________Title____________________________

 

With This Completed application, we require the below:

 

1.    Is your company listed in the phone book yellow pages?  [  ] YES   [  ]  NO

2.       A copy of your state retail tax certificate.

3.        Sign and return our Resale / Tax Exemption Certificate (included)..

4.       All information must be completed for application approval, No Exceptions.