Dealer Program Application

Name of Dealership:_____________________________________________

Billing Address: _____________________________________________

Shipping Address: _____________________________________________

City: _______________ State:_________ Zip:_________

Telephone:____________________ Fax:____________________

Web site:_____________________ Email: _______________________

Number of years in Business: ____________________________________

Federal Tax Number: ____________________________________________

State Resale Number (if applicable)_________________________________

Banking Information: ___________________________________________

___________________________________________

_____________________ Contact:_______________

Please list up to (3) business references:

Please fax or email this page and (1) copy of your business license, (1) copy of your resale permit, and a (1) copy of your most recent Yellow page ad to:

Fax: (323) 721-7888, or email to : sales@cycletires.com

Tomahawk Superbike Tires

6900 Acco Street

Montebello, CA. 90640