Become a Dealer Form

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Name:

Title :

Telephone:

E-Mail:

Company Name:

Company Address:

City:

State:

Zip:

Country:

Company Web Site URL:

Please provide a brief overview of your company:

What specific markets do you specialize in?:

What is your geographic coverage?:

What is your annual revenue and turnover as it relates to the markets you work in?:

How many locations do you currently operate in?:

What are your top selling products?:

Do you have technicians/auto electricians on staff?:

yes

If yes, How many?:

Do they regularly handle installations, trouble shooting, and operator training?:

yes

If yes, please specify:

Do you have an outside sales team?:

Yes

If yes, How many?:

Are they calling on end users, OEMs, or second tier distributors?:

Yes

If yes, please specify:

Do you carry other products that require a significant amount of service and support? (check all that apply):

What would you estimate your annual volume of units (number of system installs) to be on our product in year 1?:

What would you estimate your annual volume of units (number of system installs) to be on our product in year 5?:

In what market(s)?:

If operating outside of the USA, do you regularly import products from the US?:

Yes

Do you do business in US currency?:

Yes

Who do you use for logistic services?:

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