DEALER APPLICATION

DEALERSHIP INFORMATION:                                                                 (For faxing, please print, complete and fax to: 989-227-0801)
Dealer Legal Name: 
Mailing Address:     
Shipping Address:   
Phone Number:        Fax: 
Is this dealership a full service facility? (i.e. service, parts, hitches, etc.): 
Do you pay cash or floor plan?  If floor planned, which company? 
Web Site:        Transportation:
Federal I.D. #:  Sales Tax I.D. #:
CONTACT INFORMATION:
General Manager: Contact Person:
Cell Phone #:       Cell Phone #:    
E-Mail Address:   E-Mail Address:
OWNERSHIP INFORMATION:
Individual:   Corporation/Type: Partnership:   Other:
Owner/President:     SS#: 
Home Address:      
Cell Phone Number: Home Phone #:  
BANKING INFORMATION:
Bank Name:         Phone #:           
Bank Address:     Contact:            
Account Number: 
CURRENT MAJOR SUPPLIER REFERENCES:
Name:  Address: 
Phone: Contact:  
Name:  Address: 
Phone: Contact:  
 

I authorize the above references (including banking) to release information to Legend Manufacturing, Inc. in order to determine an open account.
  PLEASE ATTACH A LEGIBLE COPY OF YOUR SALES TAX EXEMPTION CERTIFICATION!
  I HAVE READ AND AGREE TO ABIDE BY THE TERMS OF THE LEGEND DEALER REQUIREMENTS:
  Authorized Signature:___________________________________  Title: _________________________