World of Powersports Wholesale Parts – Dealer Application
http://www.dealerorders.com
2635 N. 22nd Street, Decatur, Illinois 62526 USA – Tel (217) 233-1245 Fax (217) 233-0008
v Honda v Kawasaki v Yamaha v Suzuki v Polaris v Sea-Doo v Bombardier v Ski-Doov Triumph v Arctic Cat v
Company Name:
Primary Contact Name:
Mailing Address (Street):
Mailing Address (City):
Mailing Address (State and Zip code): Country
,
UPS Delivery Address: (if different than above)
Email Address:
Website URL:
Business Type: (Corp., Partnership, Etc)
Corporation (C) Corporation (Sub-S) Partnership Sole-Proprietor
State Resell Number:
Credit Card to be used for Orders: (Enter COD if COD Account)
(you can write it on fax copy if you wish)
Card Type (Circle One): MC Visa
Exp Date:
Name as it Appears on Credit Card:
Credit Card Billing Address (Street):
Credit Card Billing Address (City):
Credit Card Billing Address (State and Zip code):
Authorization to Charge: I hereby certify that by providing the above credit card information I have authorized World of Powersports to charge this credit card for any order shipped to the address shown in the above spaces.
PRINT CONFIRMATION PAGE AND FAX FOR CONFIRMATION
Cardholders Signature: __ _________________________________________________________________
Trade Reference: (List a Powersports Distributor you do business with)
Account # or Contact:
Application Checklist:
1) Credit Card Number on Application.
2) Faxed Application, Credit Card Authorization & Copy of Business License to World of Powersports at 888-291-7278 or 217-233-0008
Fax Completed Application to (217) 233-0008 or 888-291-7278
Apply Online at http://www.dealerorders.com
YOUR ARE APPROVED AS A DEALER ONCE YOU FAX ABOVE INFORMATION.
(Only Click Once)