Regional Lines Disclosure Form

Regional Lines Disclosure Form
County:
Regional Show Information
Regional Show:
Show Dates:
Dealership Information
Name of Dealership:
Dealership Address:

Street Address

Street Address Line 2

CityState

Zip Code
I am the:
If you are a Designated Signer, FRVTA must have a copy of your designation as the dealer representative signed by the Owner/Dealer Pricipal/Corporate Officer of the dealership.
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Authorized Representative:

First NameLast Name
Cell Phone Number:
Format: (000) 000-0000.
Office Phone Number:
Format: (000) 000-0000.
Email:
Space Number(s):
Is the On-Site Representative the same as the above Authorized Representitive?
On-Site Representative:

First NameLast Name
Cell Phone Number:
Format: (000) 000-0000.
Office Phone Number:
Format: (000) 000-0000.
Email:
Dealership Acknowledgment of Sale Responsibility

I understand that the address for the regional show is in {county} county and certify on behalf of the dealership that it is able to bring the line makes listed on this document to the regional show by virtue of one or more of the following reasons:
Dealership Line Makes

What we need is specific manufacture name (make), brand name, model name, and the unit type/class. Each model needs to be listed individually.

Please refer to the below examples:

Keystone RV - Dutchmen Mfg. - Astoria - Travel Trailer

Forest River - Cherokee - Alpha Wolf - Travel Trailer
Dealership Line Makes
File Upload

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Should be Empty:

Regional Show Information