Application

(Dealer Log-In temporarily out of order)

Are you an established bicycle or multisport retailer / independent rep. / distributor / importer?  Valdora may be exactly what you are missing!  Complete the application below to be considered for membership.  All fields must be completed.  Retail, Distribution, Importer, and Independent Sales Representative territories available!

Print & Fax Application....Click here.....

Date:                     

Type of business:  N. American Retailer  Importer 

                              Independent Rep.    Distributor

Doing Business Since: 

How Long Under Current Ownership? 

Business Name:    

D.B.A.                   

Corporate Name:         

Street Address:            

City:                             

State / Province:          

Post Code:                   

Country:                       

Telephone #:                 

Fax #:                              

WebSite:                        

Business Form:  Corporation;    Partnership;   Proprietorship

Tax Exempt:  Yes; No 

 (USA) Federal ID#:                          

Resale Certificate# (if retailer):       

Tax Location (state, county, city):    

Trade References

1)  Business Name:                                        

 Telephone #:                                                

Fax #:                                                          

2)  Business Name:                                        

Telephone #:                                                

Fax #:                                                          

If Proprietorship or Partnership:

1) Owner 1                         

2)  Owner 2                        

If Corporation:

1)  President                      

2)  Vice President               

How did you learn of Valdora Cycles? 

 

Comments:                                                               

E-mail Address:                                                                 

Confirm E-mail Address: