Untitled Document


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
Do you have an existing store front?	No	Do you have a repair facility?	No
Will applicant be Sole Owner of Dealership?	Yes	Will applicant personally manage Go-Ped® Operations at the dealership?	Yes
Will applicant be Sole Owner of Dealership?	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