Become A Legend Manufacturing, Inc. Dealer

Become an Authorized Legend Manufacturing, Inc. Dealer

Fill the dealer application form out below. For security reason, we are not taking applications through e-mail. After the form is filled out completely, please print it and fax it to 989-227-0801. PLEASE ATTACH A LEGIBLE COPY OF YOUR SALES TAX EXEMPTION CERTIFICATION! Thank you.

Dealership Information

Dealer Legal Name: *

Mailing

Mailing Address:------------------- *

Mailing City:----------------------- *

Mailing State/Province and Country: *

Shipping

Shipping Address: ------------------- *

Shipping City: ----------------------- *

Shipping State/Province and Country: *

Phone Number: --------------------- *

Fax Number:------------------------ *

Is this dealership a full service facility? (i.e. service, parts, hitches, etc.): Yes No *

Please tell us how you pay: ------------------------------------------- Cash Floor Plan *

If floor planned, which company?---------- *

Do you have a website? Please put url here:

Transportation: ---------------------------- *

Federal I.D. Number: --------------------- *

Sales Tax I.D. Number: ------------------- *

Contact Information:

General Manager

General Manager: *

--Phone Number: *

-E-Mail Address: *

Contact Person:

-Contact Name: *

-Phone Number: *

E-Mail Address: *

Ownership Information

Business Structure:----------------------- *

Owner/President :------------------------ *

Owner/President Social Security Number: *

Owner/President Home Address:--------- *

Owner/President Home Number:--------- *

Owner/President Cell Phone :--------- --- *

Banking Information

Bank Name:---------- - *

Bank Contact Person:-- *

Bank Phone Number :-- *

Bank Address :--------- *

Bank Account Number : *

Current Major Supplier References

Reference One

Business Name *

Contact Name *

Phone Number *

-------Address *

Reference Two

Business Name *

Contact Name *

Phone Number *

-------Address *

I HAVE READ AND AGREE TO ABIDE BY THE TERMS OF THE LEGEND DEALER REQUIREMENTS:

Authorized Signature:
I authorize the above references (including banking) to release information to Legend Manufacturing, Inc. in order to determine an open account. ------------- * Signature

* Title