Distributor Application Form
COMPANY NAME
ZIP CODE
STATE
CITY
STREET ADDRESS
NAME OF CONTACT
TITLE OF CONTACT
HOW LONG HAS COMPANY
BEEN IN BUSINESS?
BEEN IN BUSINESS?
HOW DO YOU WISH TO BE
CONTACTED IN REGARD TO
YOUR APPLICATION?
CONTACTED IN REGARD TO
YOUR APPLICATION?
Does your company have
experience in selling advertising?
If so, please explain.
experience in selling advertising?
If so, please explain.
NUMBER OF EXISTING
ACCOUNTS?
ACCOUNTS?
EXISTING PRODUCTS or
Services THAT YOU ARE
CURRENTLY SELLING INTO THIS
REGION
Services THAT YOU ARE
CURRENTLY SELLING INTO THIS
REGION
NUMBER OF EMPLOYEES
REGION/AREA THAT YOU WISH
TO DISTRIBUTE BRANDITTV
TO DISTRIBUTE BRANDITTV