iButtonlock.com


	Reseller / Dealer Application

New Dealer Application Request Form

Please fax or mail this form to:
Attn: Dealership Request
Uaccess LLC, Inc.
1904 University Business Drive, Ste. 304
McKinney, Texas 75071
USA
Fax: 972-268-9449

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: