Dealers Enquiries!

	a. Contact information
First Name
Last Name
Company Name:
Position:

Street Address:
City/Town:
State/Prov:
Post/Zip Code:
Country:

E-mail address:
Web site:

Phone:
Phone (Cell):


	b. Applicant information
I am interested in applying as a/an:
	Dealer Franchisee Independent

Do you currently own and/or manage a business?
	Yes No
	If you answered “Yes” please indicate the length of your business? Months/Years

What type of products do you currently offer or have offered in the past?
	sports goods recreational transportation entertainment clothing Other
Please specify the type and/or model of products if you offer Light Electric Vehicles


Do you have any prior experience and/or knowledge related to Light Electric Vehicles?
	Yes No
	If you checked “Yes”, please explain:


Other comments: