Home>>Our Reseller
  Reseller / Dealer Application  

 

 
New Dealer Application Request Form

Please fax or mail this form to:
Attn: Dealership Request
Uaccess LLC, Inc.
4814 Dozier Road
Carrollton, Texas
USA
Fax: 469-541-0305

1. Company Information
Company Name:  
Address:  
City, State, Country:  
Postal or Zip Code:  
Phone Number:   Fax Number:  
Email Address:   Web Site:  
How Many Years in  Business?   Years under present name:  
Other Brach Locations?  

2. Ownership
Sole Ownership: Partnership: Corporation:   
If Corporation: Give Name, State, Country, Date of Corporation

3. Key Contacts
President/Owner:  
Sales/Marketing Manager:  
Financial Manager:  
Installation/Service Manager:  
Engineering Manager:  

4. Market / Product Information  
Current and Planned Market Focus:  
Projected Annual Sales Forecast:  
Products Interested
Keypad Lock iButton Lock Door Controller Locker Lock Hotel Lock

5. Customer References
Customer Name:
Contact Person:
Telephone Number:
 
Customer Name:
Contact Person:
Telephone Number:
 
Customer Name:
Contact Person:
Telephone Number:
 

6. Supplier References
Supplier Name:
Contact Person:
Telephone Number:
 
Supplier Name:
Contact Person:
Telephone Number:
 
Supplier Name:
Contact Person:
Telephone Number:
 




     
 
@ ibuttonlock.com. All rights reserved.