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Dealer Request Form

Supplying this information does not establish an agreement with Cannella Custom Cycles, LLC. 

After review of your initial request you will be asked to provide the following information via email (scan documents/email or mail hard copies):  Business License, Resale Certificate, Location Picture and Completed and Signed Distributor Agreement.

If you have any questions, please contact us at info@cannellacustomcycles.com.

Company Name:
Proprietor/Principal Partner:
-
Main Address:
City:
State:  Zip: 
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Shipping Address:
City:
State:  Zip: 
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Website:
Phone:
Email:
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Year Established:
Years at Current Location:
Federal EIN #:
State Tax #:
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What type of reseller is your company? (Check all that apply.)
  Catalog Mail Order
  Retail Store
  On-Line Mail Order
  Other (Please describe)
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How did you hear about Cannella Custom Cycles?
 
   
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:: Dealer Request Form ::
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