Form 9 Dealer Cancellation

Distributor / Dealer Change and Cancellation Request
This form must be completed by your territory distributor. If you are wishing to make changes to or cancel your dealer agreement your distributor has to be informed.
What is being requested
What Change is requested
Responsible Distributor Information
Date

MonthDayYear
Date
Distributor GPA
Distributor Name
Distributor Contact Name

First NameLast Name
Distributor Contact E-mail
example@example.com
Distributor Contact Phone #
Format: (000) 000-0000.
Business To Apply Changes To
Number of locations requesting changes
Dealer #1 GPA
to change or cancel
Current Listed Dealer Name #1
New Dealer Name #1
Dealer #2 GPA
to change or cancel
Current Listed Dealer Name #2
New Dealer Name #2
Dealer #3 GPA
to change or cancel
Current Listed Dealer Name #3
New Dealer Name #3
Dealer #4 GPA
to change or cancel
Current Listed Dealer Name #4
New Dealer Name #4
Dealer #5 GPA
to change or cancel
Current Listed Dealer Name #5
New Dealer Name #5
Dealer #6 GPA
to change or cancel
Current Listed Dealer Name #6
New Dealer Name #6
Dealer #7 GPA
to change or cancel
Current Listed Dealer Name #7
New Dealer Name #7
Dealer #8 GPA
to change or cancel
Current Listed Dealer Name #8
New Dealer Name #8
Dealer #9 GPA
to change or cancel
Current Listed Dealer Name #9
New Dealer Name #9
Dealer #10 GPA
to change or cancel
Current Listed Dealer Name #10
New Dealer Name #10
Complete and provide Completed W-9 Tax Form.

IRS W-9 page
Please attach Completed W-9 Form

Browse Files

Cancelof
Has the dealer been informed they are being cancelled?
Dealer Contact Name

First NameLast Name
Dealer Contact Email
example@example.com
Dealer Contact Phone Number

Area CodePhone Number
New Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Request Service Level Change to:
Brief explanation of reason for request:
Business Hour ID
Should be Empty:

Distributor / Dealer Change and Cancellation Request