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Dealer Inquiry Form

  • General
  • Product Info
  • Sales/Ad Info
  • References
  • Additional Info



           

1. Contact Info

         

Contact

 

Phone

Ext.

Title

 

Email

         

2. Company Info

     
Company   Phone Ext.
Web site   Address
Yr.established    
No. of offices   City
Locations   State

 

  Zip  

 

         

>> Next



         
 

3. Product Info

     
 

No. of Direct Product Lines Carried:

Top 3 lines

 

No. carried through distribution

 

     

 

         

>> Next

     
     
     
     
     
     
     
     
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4. Sales/Advertising Info

   
 

Total Sales

Advertising Budget

 

% Government

% Web

 

% K-12

% Print

 

% Corporate

% Radio

 

% Higher Education

% Shows/Events

         

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5. References

       
  Please list company references (i.e Manufacturers, Customers, Other)    
 

Name

Relationship

Phone

 

Name

Relationship

Phone

 

Name

Relationship

Phone

             

>> Next

     
     
     
     
     
     
     



   
 

6. Additional Info

 

Please describe the value you would add to our company as a reseller.

 

 

How do you think Qwizdom will compliment your company's offerings?

 

 

What do you need from Qwizdom to be successful?

 

       
     
 
 
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