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Rampit USA, Inc.
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Dealer Application Form
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Application
Business Information
Applicant Name
*
First
Are you the business owner?
*
Yes
No
Business Owner Name
*
First
Legal Business Name
*
Are you doing business as this name?
Yes
No, I'm doing business as another name
Date business started
*
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1925
1924
1923
1922
1921
1920
Veteran owned status
*
VOSB
SDVOSB
None
Which of the following describes your business?
Please check all that apply
Franchise
Dealer
Independent
Accessories
Repair
Other
Do you currently sell or service handicap access ramps?
Yes
No
Which types of ramps?
*
Please check all that apply.
Residential ramps
Commercial ramps
Portable ramps
ATV/Recreational ramps
None of the above
What brands?
Business Address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone Number
Fax
Email
*
Website
What type of property is this?
*
Residential
Commercial
Is there a liftgate?
Yes
No
Billing Information
Accounting Email
Purchasing Email
Federal ID #
Resale Tax #
Business References
Please add 3 references below.
Business Name
Location
Contact Name
Position
Phone
Email
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Document Uploads
Please upload the following documents:
Completed Michigan Sales Tax Exempt Form
General Liability Insurance
Upload files here
*
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Select files
Accepted file types: pdf, Max. file size: 32 MB, Max. files: 2.
Consents
Consent
*
By submitting this form, you confirm that all information presented above is true and accurate to the best of your knowledge.
*
Consent
*
You are the business owner, partner or corporate officer.
*
Name
This field is for validation purposes and should be left unchanged.
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