Gulf Coast Veloteq Dealer Application

If you are interested in becoming a dealer for the ebikes sold by Gulf Coast Veloteq, please download this form to fax or fill in the following contact information:

Name *
Title
Business Name
Address
Address
City
State
Zip Code
Country
Work Phone
Home Phone
Fax
E-mail *
Web Site URL
Do you sell to?		End User Only Wholesale Only Sell to Both
Do you Have a Showroom?
Do you Provide Service?
Do you Maintain Parts Inventory?
Do you Own your business location?
Do you Lease Business location
Do you have a license to do business in your State?
How many years have you been in business?
How many years at your present location?
How many people are on your staff?
What is your prior experience in the personal electric vehicle market? How do you plan to promote the sales of Veloteq products, e.g., store sales, internet sales or both?
Are you willing to cooperate with other distributors by supplying parts or inventory from time to time?
Are you interested in promoting the full range of Veloteq products or only specific types?

* = Required fields