Dealer Inquiry Form
Please fill out as completely as possible. Partially completed forms will not be submitted.
Do you own a retail store currently?
YES
If you do not, please explain.
Name of Business
Legal Structure of Business
Sole Proprietor
Partnership
LLP Corp
LLC Corpr
Corp
S Corp
Principal Contact
Street Address
City
State
Zip
Phone
E-Mail
Web Site
Do you have a computer with a Static IP Address at your store(s)?
YES
Do you sell wireless products and services currently?
YES
If YES what do you carry?
Business Type & Industry
Years in Business
Annual Estimated Revenue
less than 100,000
between 100,000 and 1,000,000
over 1,000,000
Current Number of Employees
Full Time
Part Time
Current Count of Existing Customers
Describe your business
What is unique about your business that gives you and advantage over your competition?
Do you have multiple locations?
YES
What locations would you want to sell out of?
Please provide three (3) business references
How did you hear about us? Did anyone refer you?