View Cart
 Sign Up
Fill out Credit Application

DEALER REGISTRATION

First Name* Last Name*
Company
Address*
 
City*
State*
Region*
Country* Zip/Postal Code*
Phone* Email Address*
Password* Repeat Password*
Check here if you don't want
to receive information on Gefen   
promotions and special deals
* - required field

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

TRADE REFERENCE #1

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

TRADE REFERENCE #2

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

TRADE REFERENCE #3

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