HILEY DEALERS APPLICATION FORM
Applicant Business Information
Email *
Complete Name *
DBA (Doing Business As , If Any) *
Billing Address (  (Complete Address) - City, State/Province, Zip/Postal Code *
Email *
Contact Number *
WhatsApp Number *
Type of Business *
Start Date of Business *
MM
/
DD
/
YYYY
Federal tax ID *
Resale License Number
What HILEY scooter model do you want to purchase? *
Required
On the Models that you picked, please specify how many of each do you want to purchase: *
Ownership *
Complete Shipping Address  (City, State/Province, Zip/Postal Code, Country) *
Do you plan to dropship to your customer's addresses? *
List other similar products vendor you currently do business with:
 *
Do you have a showroom/retail storefront?
 *
If yes, what percentage of retail floor space would be allocated for HILEY products?
 *

Do you currently or plan to do online business through the Internet?


 *
If yes, what percentage of your total sales would result from online sales?
 *

Who will order for this account (Person in-charge for ordering)?

 *

I hereby state that the information contained herein is correct and not misleading. I understand the above information is given in confidence for the sole purpose of requesting an account with HILEY.

State the following: 1. Applicant’s Name, 2. Designation, 3. Date


 *
A copy of your responses will be emailed to the address you provided.
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