This is Maverick Racing Factory Inc. Online Application Form
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Motorcycle Brand:
*
HONDA
YAMAHA
SUZUKI
KYMCO
KAWASAKI
Others:
Preferred Model: HONDA
Please Select
CLICK 125i
CLICK 160
ADV 160
PCX 160
WINNER X
BEAT STANDARD
BEAT CSS/ISS
WAVE 125 ALPHA
TMX SUPREMO
AIRBLADE 150
WAVE SPOKES
WAVE 110R DISK
WAVE 110 DRUM
XRM DS
XRM MOTARD
XRM DSX
XRM RS
GTR SUPRA 150
XR 150
CBR150
CRF 150
CRF 250
TMX 125
Preferred Model: YAMAHA
Please Select
MIO SPORTY
MIO I 125
MIO AEROX
MIO AEROX S
MIO GRAVIS
MIO AEROX S DOXOU
MIO SOUL I 125
MIO SOUL I 125S
NMAX ABS 155
NMAX NON ABS 155
SIGHT SPOKES
SIGHT CAST
XMAX 300
SNIPER 150
SNIPER 150 DOXOU
YTX 125
Preferred Model: SUZUKI
Please Select
AVENIS
BURGMAN
SKYDRIVE FI 125
SKYDRIVE SPORT
SMASH
SHOOTER 115 FI MAGS
SHOOTER 115 FI SPOKES
RAIDER J 115 FI MAGS
RAIDER J 115 FI SPOKES
RAIDER R 150 CARB
RAIDER R 150 FI
GIXXER FI
GSX R 150
GSX S 150
Preferred Model: KYMCO
Please Select
LIKE 125
SUPER Z 125
SUPER 8 150
SUPER Z 150i
LIKE 150i
LIKE 150i Noodoe
XTOWN 300 FI ABS
XTOWN 300i Noodoe
XCITING 300i ABS
XCITING S 400i
VISA R 110
Preferred Model: KAWASAKI
Please Select
BARAKO
Preferred Color:
*
Preferred Date to Purchase Unit
-
Month
-
Day
Year
Date
Cash / Installment
*
Cash
Installment
Contact Information
Name
*
First Name
Last Name
Birth Date:
-
Month
-
Day
Year
Date
Mobile/ Telephone Number:
*
E-mail
*
Location
*
Complete Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Location
City
How long have you lived in your given address?
0-1 Year
1-2 Years
3-4 Years
5+ Years
Source of Income
Please Select
Self Employed
Employed
OFW
Remittance
Delivery Rider
Others
Employment Information
(If Employed)
Present Employer
Occupation
Name of Business
Character Reference
Please give at least (3) references
Name:
*
1st Reference
Contact Number:
*
Relationship:
*
Name:
*
2nd Reference
Contact Number:
*
Relationship:
*
Name:
*
3rd Reference
Contact Number:
*
Relationship:
*
Requirements: Government ID's, Proof of Billing, Proof of Income
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I hereby agree that the information given is true, accurate and complete as of the date of this application submission. *
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