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Application Form

 

Dealer Application

Please complete the dealer application below and we will have one of our representatives contact you within 24 hours.

NOTE: All required fields (*) must be completed.

If you have trouble supplying any of the below information, please apply by calling our Sales Department at (415) 226-1122 ext 1 or download an application form.

  CONTACT INFORMATION
First Name* Phone*

Last Name*

Fax*
Title* Email*
    Verify Email*

  COMPANY INFORMATION

Country* (for North American dealers only)
For dealership outside of North America, please contact us at
info@point-sourceaudio.com.

Company Name*

City*

Address 1*

State/Province*

Address 2

Postal Code*


  SHIPPING ADDRESS (if different from above)

Company Name

City

Address 1

State/Province

Address 2

Postal Code


  BUSINESS INFORMATION

Years in Business*

President's Name*

State Reseller No.*

CompanyWebsite

Federal Tax ID/SSN*

Number of Employees*

Business Entity*

Corporation
Partnership/LLC
Sole Propietorship

Type of Business*

Systems Integrator
Retail Store/Warehouse
Internet Only


  Please provide three (3) credit/trade references*:

Credit amount desired*


 
Please list bank references*:

CLICK HERE TO READ OUR TERMS AND CONDITIONS
(Click again to hide.)

 * I have read and agree to the Dealer Agreement Terms and Conditions and I am duly authorized to enter into this agreement.




The More You Know, The Better We Sound.   
Copyright © 2010 Point Source Audio