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Company Name
 
Applicants Name
 

Applicants Title

Applicants Date Of Birth
(mm/dd/yyyy)
Company Address
Address Cont.
City
State
Zip
 
Phone
Fax
Mailing Address
Mailing Address Cont.
City
State
Zip
 
Date Business Started
(mm/dd/yyyy)
 
Primary Products and Services
Primary Brands / Suppliers
Website
Email
Do you have an existing store front?
Yes
Do you have a repair facility?
Yes
No No
Will applicant be Sole Owner of Dealership?
Yes
Will applicant personally manage Go-Ped® Operations at the dealership?
Yes
No No
 
 
Which Go-Ped® Product line(s) are you interested in carrying?

(Check all that apply)
Full Line
Do you plan on retailing the Go-Ped® brand online
 
Electric Yes, online only
Gas Yes, online and at store
Karts No, store only
Parts / Service  
 
Website:
initial investment
   
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