Cinetics Authorized Dealer Program Application
All authorized dealers and distributors must complete the Cinetics Authorized Dealer Program Application. Thank you for your interest in Cinetics. Thank you!
Company Name *
Your answer
Primary contact email address *
Your answer
Primary Contact *
First Name
Your answer
*
Last Name
Your answer
*
Phone Number
Your answer
Billing Address: *
Address 1
Your answer
Address 2
Your answer
*
City
Your answer
*
State
Your answer
*
Zip
Your answer
Shipping Address *
Same as Billing Address?
Address 1
Your answer
Adress 2
Your answer
City
Your answer
State
Your answer
Zip
Your answer
What is your legal business name? *
Your answer
What is your company DBA or DBAs?
Your answer
How many years have you been in business?
Your answer
What is your company website?
Your answer
What is your primary vertical? *
In which country do you primarily do business? *
Your answer
Do you operate business outside of your primary country?
If yes, please list the countries in which you operate:
Your answer
Do you have a retail storefront? *
If yes, how many physical locations are there? *
What are your total annual sales? *
What percentage of sales come from eCommerce? *
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