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Business Name *

Doing Business As (DBA)

Primary Contact Name *

Phone/Mobile *

Fax

Company Website

Primary Contact Email *

Business Address

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Additional Shipping Instructions

Business Information

Type of Business *

Custom Integrator / Dealers

Distributor

Retailer

Consultant

Primary Sales Channels

Brick and Mortar / Showroom

Online

Consultation

Select all that apply

Do you sell to Consumers, Businesses or Both?

B2B

B2C

Select all that apply

Percentage of Brick and Mortar Sales

Percentage of Online Sales

Estimated Total Annual Sales (From Customer)

eCommerce and Lead Finder Sites Used

Include names of all eCommerce platforms (Amazon, eBay, Etsy, etc.) you sell or trade on and any Service Finder sites you use as well (Angies, etc.)

Geographic Location *

Regional spaces you cover, can be City, County, State, Country, Regional Name, etc.

What brands do you currently distribute or sell? *

What Product line have you distributed the longest? How long have you distributed the product line? *

What is your Go-To-Market Strategy (How do you sell)? *

How many in-field sales people (employees)? *

How many independent/contracted sales representatives do you use? *

How often do your sales people travel in the territory? *

Are any sales people remotedly located? If so, where? *

Do you have any staff in your distribution company dedicated to technical support? *

Yes

No

Do you have any staff in your company who could provide training to dealers? *

Yes

No

Do you conduct events or training for dealers? If yes, how often and what type of events? *

What is the greatest benefit you have to offer a manufacturer, as a distributor, in your territory? *

Type of Entity *

Federal Tax ID Number

State Sales Tax Exemption Number

Business Start Date

Resale Certificate

Business License

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Account Information

Business Address

Business Information