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, I currently own a retail store. If you do not, please explain.

Business Information

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

Additional Information

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 Full Time Employees Current Number of Part Time Employees 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 d you hear about us? Did anyone refer you?