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Watchnet DVR-Dealers

DEALER REGISTRATION

COMPANY INFORMATION :

Business Name President/Owner

DUNS Number Authorized Purchaser

Address Tax ID / PST

Country Email Address

State / Province Business Phone

City Business Fax

Zip / Postal Code Website Address

Business Type Purchased From

Length of time at this address

Years (s)

Months (s)

List of Affiliated companies

BANK REFERENCES : (All Information submitted will be kept in strict confidence)

Bank Name Address

Account Number State / Province

Transit Number City

Phone Number Zip /Postal Code

GENERAL BUSINESS PROFILE :

Which category best describes your company's business ?

System IntegratorDistributorRetail StoreCorporate Reseller
VAR/System ConsultantE-commerceDealerOEM
Educational ResellerExporterOther

Which of the following best describes your company's total monthly purchases with all sources ?

Less than $10,000$10,000 - $49,999$50,000 - $99,999$100,000 - $299,999
$300,000 - $499,999$500,000 - $999,999$1000,000 - $100,000,000$100,000,000 +

How many employees does your company have ?

1 - 56 - 1011 - 2021 - 5051 - 100101 - 300300 +

What were your company's total revenue last year ?

Less than $10,000$10,000 - $49,999$50,000 - $99,999$100,000 - $299,999
$300,000 - $499,999$500,000 - $999,999$1000,000 - $100,000,000$100,000,000 +

Is there a parent company ? YesNo If Yes, Parent Company's Name and Address.

Name Address

How many branch offices does your company have ?

Branch 1 Address

Branch 2 Address

How did you find out about Watchnet International ?

Trade Show (which one?)Reffered by another company (which company?)Advertisement (please describe)
Internet (which site?)Other (please specify)

How :

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