Thank you for your interest in becoming a dealer for T3 Motion. We offer a uniquely exciting and profitable opportunity for dealers to represent a product category that is poised for unprecedented commercial growth.

In order to establish a convenient distribution channel for our growing customer base, we are seeking established dealers who can provide a first-class sales and service experience while also delivering excellent business results. Please complete the application below and e-mail to our office at sales @t3motion.com or Fax: Attn Dealer Development (714) 619 - 3616

We will not be able to provide you additional information without first receiving a complete application.

General Background Information

Company Name:

______

Representative Name:

______Title:______

Business Address:

______

City: ______

State/Province:______

Country: ______Postal Code: ______

Fax: ______

Phone: ______

Mobile: ______

Email: ______

Web site: ______

Business Background

Date business was started: ______

Business type (Corporation, Partnership, Sole proprietor, etc.):

______

Dealer License #: ______

Federal Tax ID: ______

What are your gross annual sales for the most recent year? $______

Number of locations: ______

Second location (if applicable):

Address: ______

City:______

State: ______Zip: ______

Phone: ______

Facilities

What is the size of your primary facility?

Showroom ______Sq. Feet / Meters

Service Area______Sq. Feet / Meters

Parts/Accessories ______Sq. Feet / Meters

What is the size of your second facility (if applicable)

Showroom ______Sq. Feet / Meters

Service Area______Sq. Feet / Meters

Parts/Accessories ______Sq. Feet / Meters

Please attach interior and exterior photos (File attachment, if applicable) of your facilities.

Employees

Primary location: ______

Total number of employees: ______

Memo:

Sales: ______Memo: Commercial Account Representative(s)______

Service: ______

Parts: ______

Finance and Insurance: ______

Second location: ______

Total number of employees: ______

Memo:

Sales: ______Memo: Commercial Account Representative(s)______

Service: ______

Parts: ______

Finance and Insurance: ______

Current product lines carried: (E.g., Segway, Honda, Yamaha, etc.)

1. ______Percent of sales ______% Years carrying line: ______

2.______Percent of sales ______% Years carrying line: ______

3.______Percent of sales ______% Years carrying line: ______

4.______Percent of sales ______% Years carrying line: ______

5. ______Percent of sales ______% Years carrying line: ______

Current Commercial Accounts:

______

Sales

Total sales 2011 $______

Total sales 2010 $______

Total sales 2009 $______

What financial institution(s) do you use for inventory financing?

1. ______

2. ______

Marketing and Advertising

What is your current marketing budget? $______

In which types of commercial events does your dealership participate? (E.g., Police/Security conventions, trade shows etc.)

1 ______2 ______

3 ______4 ______

In which types of consumer sales events does your dealership participate? (Demo days, racing, regional retail shows etc)

1 ______2 ______

3 ______4 ______

Where do you currently advertise?

1 ______2 ______

2 ______4 ______

Please attach a Commercial and Consumer Sales & Marketing Plan plus an Estimate of T3 Sales for the upcoming year.

(Note: As commercial sales are estimated to account for a substantial percentage of your initial sales please emphasize this segment in your sales and marketing plan.)

Note: This is an Application for a Dealership only. T3 Motion Inc. does not assume any obligation or liability for any cost or expense incurred in preparing or submitting this application, nor for any liability or obligation contracted by any parties submitting this Application. All Applicants MUST BE APPROVED by T3 Motion, and Sales and Service agreements entered into and executed by both parties and delivered to you before a dealership relationship can commence. All Agreements, orders or any document, paper, or instruments submitted with such Application shall not be binding upon T3 Motion until Sales and Service Agreements are duly executed by both parties.

Applicant Signature(s)

______Signature / Printed

Percent of Ownership______

Date ______

Partner (if applicable)

______Signature / Printed

Percent of Ownership______

Date ______

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