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ECLIPSE Products Sport and Touring Motorcycle Luggage Since 1973 |
Eclipse Mfg. Dealer Application Dealer Categories: Eclipse Luggage Company name: __________________________________________________________________________________________ DBA: ___________________________________________________________________________________________________ Contact Person: __________________________________________________________________________________________ Shipping Address: ________________________________________________________________________________________ Phone Fax: _________________________________________________________________________________ Federal Tax ID or Social Security Number: ________________________________________________________ Date Business Established (year): _______________________________________________________________ TRADE REFERENCES Reference #1 Name: _____________________________________________________________________________________ Address: ______________________________________________________________________________________________ Phone: _____________________________________________________________________________________ Reference #2 Name: ______________________________________________________________________________________ Address: _______________________________________________________________________________________________ Phone: _____________________________________________________________________________________ Reference #3 Name: ______________________________________________________________________________________ Address: ________________________________________________________________________________________________ Phone: _____________________________________________________________________________________ AUTHORIZED CREDIT CARDS (not required on C.O.D. orders) Card#1 Account #: ________________________________________________________________________________________ Name on Card: ___________________________________________________________________________________________ Expiration Date: _____________________________________________________________________________ CVV Code (last 3 digits from the strip on the back of the card) : ________________________________________ Billing Address: __________________________________________________________________________________________ Card#2 (optional) Account #: ___________________________________________________________________ Name on Card: ____________________________________________________________________________________________ Expiration Date: _____________________________________________________________________________ CVV Code (last 3 digits from the strip on the back of the card) : ________________________________________ Billing Address: ___________________________________________________________________________________________ Authorized signature: _______________________________________________________________________________________ Printed name: _____________________________________________________________________________________________ Title: _____________________________________________________________________________________________________ Date: ______________________________________________________________________________________ GENERAL TERMS AND CONDITIONS All orders must be paid via C.O.D. or Credit Card. We accept every size order, but orders under $75.00 value are subject to a $10.00 processing fee. Free shipping available on orders over $750.00 (48 contiguous states only). Submit Application to:
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Copyright 2005. Eclipse Manufacturing Corporation