Dealer Application Form

DEALER APPLICATION FORM

If you are a business involved in the sale of motorcycles or the supply of motorcycle parts, service or accessories, our wholesale department would like to work with you to keep British motorcycles on the road. This application is not intended for the general public.

Please fill in the application form, sign and return to British Cycle Supply Company by mail or fax; or give us a call, we may be able to set you up immediately.

BCS CUSTOMER #: _______________________________________________

COMPANY NAME:_______________________________________________

ADDRESS: ______________________________________________________

TELEPHONE:____________________________________________________

FAX:___________________________________________________________

E-MAIL:_________________________________________________________

WEBSITE:________________________________________________________

CONTACT PERSON:_______________________________________________

OWNER'S HOME PHONE NUMBER:__________________________________

Are you listed in the telephone book under your business name, or in the yellow pages, with the business name or classification clearly indicating a motorcycle business?_____

Please attach a copy of the listing, or wholesale invoices from three recognized
motorcycle parts distributors clearly showing that you are receiving a discount.

This is necessary for your company to be eligible for
full dealer discounts.

Do you have a service department capable of repairing British motorcycles?

Would you like us to refer repair customers to you? __________________

Would you like us to contact you periodically regarding dealer specials? ___

PREFERRED PAYMENT METHOD: ___________________________

CREDIT CARD #: EXPIRY DATE: _____________________________

Card Holder's Name: ________________________________________

Card Holder's Address: _______________________________________

Card Holder's Signature: ______________________________________

COD (in Canada and USA): ___________________________________

Signature of Authorized Person: _________________________________

Position: ___________________________________________________