Genuine Scooters : Dealer Request Form

Dealer Request Form Thank you for your interest in becoming a Genuine Scooters Authorized Dealership. Genuine Scooters is currently accepting applications from established 2 wheel dealers only. Please fill out the form below and a Genuine Scooters representative will contact you as soon as possible. All the information below is required Contact Information:
First Name:		Last Name:

Email Address:	*	Phone:	*

Company Information:

Company Name:

Web Site Address:

Address:

City: *	State: *	Zip: *

Phone:

Fax:

Showroom Size (sq. feet):

Financing Company (GE, Textron, DSC):

Brands Sold:

Years In Operation: