DEALER REGISTRATION

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COMPANY PROFILE

Fax Number:
President's Name:
Sales Manager's Name:
Customer Service Manager's Name:
Website:
Years in Business:
Number of Employees:
Number of Sales Personnel:
Number of Service/Tech Personnel:
Years at Location:
Annual Sales Volume:
Expected Montly Gefen Sales:
Who is Your Current Gefen or AV Supplier:
Geographical area you cover? Please be specific, only list areas your company calls on regularly.
Areas you cover on a less frequent basis
Do you have any other offices or business locations? If so, please list.
What other AV products do you sell?
Main Business Function: Reseller/Dealer Distributor Integrator
Do you offer online shopping: Yes No

Company Name:		Contact Name:
Fax #:		Account #:

Company Name:		Contact Name:
Fax #:		Account #:

Company Name:		Contact Name:
Fax #:		Account #: