FACTORY AUTHORIZED DEALER PROFILE
Please provide a response to all applicable questions.  All information provided is subject to verification and will be held in the strictest of confidence. None of the information provided will be shared with any other source and is required for the expressed purpose of evaluating the submitted application to become an SMX dealer.  Incomplete, in-accurate or unverifiable information on applications will result in the application being denied dealer status.  Your application will be reviewed by SMX and is subject to SMX's approval; upon submission you will be contacted by an SMX representative within 3 business days
DEALER PROFILE
Application Type:
Business Type:

Select Tier Level of Dealer
(Note: Tier "B" Dealers - Min. stocking inventory required)
Dealer-Distributor Legal Name
Dealer-Distributor D.B.A. Name
Sales Rep
E-mail Address
Primary Business Address
Primary Business Address 2
City
State
Country
Zipcode
Telephone 555-555-5555
Fax
Resale number
Tax ID or FIN number
Type of Dealer
(Select All That Apply)




Group Membership
(Select All That Apply)








Type of Distributor
(Select All That Apply)






PRIMARY CORPORATE CONTACT
Primary Contact name
Title
Telephone (format 555-555-5555)
Fax
E-mail

SHOWROOM SCREEN DISPLAYS
# Screens Displayed
Will You Be Displaying a SMX Screen
Is There a Dedicated Theater
Screen Size (Diagonal in Inches)
Aspect Ratio
Are There Other Screens Displayed
Do You Display Fixed, Curved or Masking
(Select All That Apply)
Yes - Fixed Screen
Yes - Curved Screen
Yes - Masking Screen
No - None of the Above

LOCATIONS - SHOWROOMS OR RETAIL OPERATIONS
Please tell us about your business and business model, by anwering the following as accurately as possible

Number of Locations
Type
Hours of Operation
Days of Week
Do You Have a Retail Location
or Showroom
Is Your Retail Location Open to the Public
Do You Have Retail or Full-time
Sales Staff
If Yes, Title and How Many
Do You Have a Service Department
If Yes, # of Employees Per Location
Do You Have An Installation Department
If Yes, # of Employees Per Location
Do You Have Workman's Compensation
Do You Have a Contractor's License
Do You Have On-site Warehousing
Do You Do Commercial Projects
Can You Accept On-site Truck Delivery

BUSINESS PROFILE
Estimated Annual SMX Screen Sales
Estimated Total Annual Sales
What % of TAS is Audio / Video / Custom Installation Electronics
Breakdown By Category (Total = 100%)
Audio % Video % Custom %
Breakdown By Market (Total = 100%)
Custom %

Retail %
Commercial %
Number of Screens Sold and or Installed By Your Company (All Vendors / Annual)
Number of "Theater" Installations Performed by Your Company
(All formats / Annual)

Below, List in Order of Importance the Lines Carried and Your Annual Volumes With Each Vendor:

Video Lines – Primary
Video Lines – Others
Screen Lines – Primary
Screen Lines – Others
Audio Lines – Primary
Audio Lines – Others

BUSINESS ADDRESS
Billing Address
Accounts Payable Contact
Direct Phone Line

SHIPPING ADDRESS
Primary Shipping Address
Other

BANK INFORMATION
Standard Freight Prepaid Terms
Cardholder Bank
Branch
Business Bank
Contact
Branch Address
City
State
Zip Code
Bank Telephone (format 555-555-5555)

FINANICAL INFORMATION
Payment Terms

 

Choose Credit Card Type
Card Number
CVC (3 digit code on back of card)
Expiration Date
Billing Street Address
City
State
Zip Code

Banking Institution
Bank Phone Number
Banking Contact

 
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