Thank you for your inquiry in becoming a dealer for Konker Motors Corp and Cleanway Transportation Corp products. Please completely fill in the form below.

GENERAL INFORMATION
Business Name: Business License Number:
Location Address: City:
Prov/State: Postal Code:
Phone No: Fax No:
Email Address: Website:

MAIN CONTACT INFORMATION
CORPORATE INFORMATION
First Name: Years In Business:
Last Name: Number of Employees:
Position: Hours of Operation:
Direct Phone: Principal Business:
Email Address: Number of additional Locations:
Cellular: Servicing Region:


BUSINESS CREDIT REFFERENCES
COMPANY NAME
CONTACT NAME
PHONE
FAX

 

OTHER INTERNAL CONTACTS
General Manager: Phone: Email:
Service Tech: Phone: Email:
Purchaser: Phone: Email:
Accountant: Phone: Email:


RELATED PRODUCTS AND ACCESSORIES CURRENTLY SOLD
BRAND
MODELS
INTERNAL CONTACT PERSON


BANK REFERRENCE
BANK
BRANCH, ADDRESS
PHONE
CHECKING/ CURRENT ACCT. NO.