MR Cycles “C-O-D” Application
774 Hendersonville Rd, Asheville, N.C. 28803 - Phone:(828)277-8600 - Fax:(828)277-7303 - email: info@mrcycles.com
H o n d a   –   K a w a s a k i   –   S u z u k i   –   Y a m a h a
 
If approved by our Credit Department, you will receive your orders on a “COD – Company Check” basis.

Please Type or Print:

Business Name:                                                                                Phone: (      )         -        

Address:                                                            City:                                    St:       Zip:          

Nature of Business:                                                                        Date Established:              

Ownership:         [  ] Individual    [  ] Partnership    [  ] Limited Partnership    [  ] Corporation

Officers, Partners, Owners:

Name:                                  Residence Address:                                                                    

City:                                    St:       Zip:           Home Phone: (      )         -         Title:                

Name:                                  Residence Address:                                                                    

City:                                    St:       Zip:           Home Phone: (      )         -         Title:                

Bank Information:

Name of Bank:                                   Address:                                                                         

City:                                                                        St:       Zip:          Phone: (      )         -        

Account Number:                                                  Bank Contact Name:                                    

Business References:

Business Name:                                           Address:                                                                 

City:                                                                           St:       Zip:          Phone: (      )         -        

Business Name:                                          Address:                                                                 

City:                                                                           St:       Zip:          Phone: (      )         -        

Business Name:                                          Address:                                                                 

City:                                                                           St:       Zip:          Phone: (      )         -        

Signature Required:

Signed:                                                                 Title:                                     Date:                 

Thank you