POWROLL DEALER APPLICATION

1.  PRINT, THEN FILL OUT APPLICATION COMPLETELY, WRITE LEGIBLY.

2.  MAKE A COPY OF YOUR YELLOW PAGES LISTING*.

3.  FAX THIS APPLICATION & YOUR YELLOW PAGES AD TO US AT

541-923-5637

Powroll accepts Visa, Mastercard & American Express or COD.  Your first COD order will be shipped COD cash, subsequent COD orders are shipped COD company check.  Powroll does not offer net accounts.

COMPANY NAME                                                                    FED TAX ID#                                    ADDRESS

SHIPPING                                                                                                                                       

Mailing (if different)                                                                                                                          

CITY                                                                          STATE                 ZIP                                   

PHONE                                                                 FAX                                                                  

OWNER/PRESIDENT NAME                                               HOME PHONE                                     

OWNER/PRESIDENT HOME ADDRESS                                                                                         

# OF YEARS IN BUSINESS                           # OF EMPLOYEES                  

BUSINESS HOURS                                                                                     

TYPE OF BUSINESS          o DEALER               o REPAIR                 o AFTERMARKET

PRODUCTS SOLD     oSTREET BIKE     oDIRT BIKE       oATV       oSNOWMOBILE    

  oWATERCRAFT    oOTHER                                              

 

*Your company MUST be listed in your main local yellow pages under Motorcycles or ATV’s.  This is a requirement for dealer status with Powroll.  Absolutely NO exceptions. 

Please don’t ask, we aren’t able to bend this rule.

The only other acceptable confirmation is:

If under a year in business:    Printed confirmation from your phone company of your future listing.

Due to time restrictions, applications received

without all information listed above will be discarded. 

Powroll Inc.  PO Box 920  Redmond OR  97756

(541) 923-1290  ●  Fax (541) 923-5637 ●  Email  mail@powroll.com