JH_dealer

Dealer Application Form

Dr. Jekill & Mr. Hyde Dealer Policy:
Factory Authorized Harley-Davidson, Indian, BMW, Triumph and Victory Motorcycle dealers in good standing with the respective manufacturer(s) are eligible to be dealers of Dr. Jekill & Mr. Hyde exhausts. All Dr. Jekill & Mr. Hyde dealer orders can only be shipped to the dealer's shipping address on file – no exceptions.

Business Information

Full Business Name

Business Structure

Other Business Structure

Authorized Dealer Motorcycle Brands

Check all that apply

Business Website

Email

Phone

Name of Principle Owner and Title

Years in Business

State Sales Tax #

Federal Identification #

Main Contact Name

Main Contact Email

Shipping Address

Address Line 1

Address Line 2

Unit/Suite

City

State

Zipcode

Non U.S. State/Province

Country

Billing Address the Same

Yes

Billing Address

Address Line 1

Address Line 2

Unit/Suite

City

State

Zipcode

Non U.S. State/Province

Country

SIGNATURES: Dealer Application will not be processed unless signed by OWNER** Required

I authorize the use of online ordering by the representives of the business named above. I understand that the business is responsible for keeping passwords confidential and resposible for all orders generated by the business representatives. I further understand that the orders placed online will be processed according to account terms without verification from a Dr. Jekill & Mr. Hyde US representative. All orders must be paid in full and shipped directly the business shipping address we have on file - no exceptions.