BECOME A POLARIS® ELECTRIC BICYCLE DEALER

Thank you for your interest in becoming a new Polaris® Electric Bicycle Dealer. Please register below and we will contact you soon.

*COMPANY LEGAL NAME & ANY "DBA" (DEALER)
*TYPE OF LEGAL ENTITY (CORPORATION, LLC, PARTNERSHIP, SOLE PROPRIETOR, ETC.)
*PRINCIPLE NAME & OWNER
*TITLE
*COMPANY ADDRESS
*CITY	*STATE	*ZIP
*PHONE	FAX
WEBSITE	*EMAIL
MAILING ADDRESS (IF DIFFERENT THAN ABOVE)
CITY	STATE	ZIP
*TAX IDENTIFICATION RESALE ID
*PRIMARY METHOD OF PAYMENT (TO EVANTAGE)
*DATE DEALER BUSINESS STARTED (MM/DD/YYYY)
*PRIMARY PRODUCTS AND SERVICE
*PRIMARY BRANDS/SUPPLIERS
*HAS THE DEALER PREVIOUSLY SOLD ELECTRIC VEHICLES?
*DOES DEALER HAVE A STOREFRONT? IF YES, PLEASE DESCRIBE (SQ FT, LOCATION, STYLE, ETC)
*DEALER CONTACT	*EMAIL
MARKETING CONTACT	EMAIL
TECH SUPPORT CONTACT	EMAIL

*Characters in the box below:

Polaris® and its vehicle body designs and names are registered trademarks of Polaris® Industries Inc. used under license. Polaris® designs, engineers, manufactures and markets snowmobiles, all-terrain vehicles (ATVs), Victory motorcycles and the Polaris® RANGER for recreational and utility use. Information about the complete line of Polaris® products, apparel and vehicle accessories is available from authorized Polaris® dealers or anytime from the Polaris® homepage at www.polaris.com.