Blink Reseller Application (Shogun Copy)

First Name

Last Name

Email Address *

Phone Number

() - (###) ###-####

Company Name

Company Website

Business Type

How Many Years in Business? *

Brief Description of Your Business *

Are you currently selling or installing? *

Number of Employees *

Market Focus *

State *

How Did You Hear About Us? *

Expected Sales Volume *

Do You Sell On Your Site or Third Party Markets? *

Do You Accept Our Map Pricing Policy? *

Do You Accept Our Terms and Conditions? *