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Company Name:
Shop Name:
Telephone:		Fax:
Email:		Web:
Address:
City:		State/Zip:

Owner/Partner/Shareholder:
Corporation:		Partnership:
Sole Proprieter:		DMV Dealer Licence:
Federal Tax ID:		Sales Tax ID:
How long have you been in business?		Number of Employees:


Primary Contacts
Sales:
Service:
Parts:

Square footage devoted to
Sales:		Service:
Parts:

What other major brands do you carry?


Bank Information
Name:
Address:
City:
State:
Zip:
Telephone:
Account:
	Yes, I have read the MotoFino Dealer Agreement and agree to it.