Sign up - Zodiac

Dealer application form

Company name *

Contact person *

Address *

Postal code *

City *

Country *

Email address *

Phone number *

Fax

Invoice Address

Same as shipping address

Company name *

Contact person *

Address *

Postal code *

City *

Country *

Email address *

Phone number *

Fax

Copy of Chamber of Commerce registration *

Select files to upload *

VAT Registration (when applicable, and for dealer in eu member states only)

Registration number

Registered name

Preferred Payment Method *

Bank transfer (Prepayment)

Mastercard / Visa

Cash on Delivery

Other

Business Type *

Authorized Harley-Davidson dealer

Authorized Victory/Indian dealer

Other Authorized dealer (please fill in brand name(s))

Independent motorcycle shop/garage

Custom bike builder

Parts and accessories distributor

Motorcycle manufacturer

Motorcycle parts and accessories web shop

Other

Opening Hours *

Monday

-

Tuesday

-

Wednesday

-

Thursday

-

Friday

-

Saturday

-

Sunday

-

Website (home page)

Website has web shop

Please provide us pictures of your company *

Minimal 1 picture from the outside and 1 picture from the inside of your (work)shop

Select files to upload *

Comments

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