Apex Technologies Dealer Inquiry Form

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Today's Date *

YYYY

Business Name (with dba if applicable) -

Primary Contact Name *

Primary Contact Email Address *

Sales Representitive *

Brands Applying For *

Meridian Audio

TPI Areospace

Apex Power Solutions

HDAnywhere

Display Technologies

LightWalls

ProtoPixel

Complete Acoustic Treatment System

nexgentec

Arvus

Required

Would you like a brand specific onboarding? *

Professional Organization Affiliation *

Azione

HTSA

ProSource

HTA

Guild Integrators Alliance

Cinergy Professional Development Group

CEDIA

None

Required

Billing Address: *

Billing City *

Billing State: *

Billing Zip Code: *

Shipping Address: (If same, write same)

Shipping City: (If same, write same) *

Shipping State: (If same, write same) *

Shipping Zip Code: (If same, write same) *

Primary Phone Number: *

Website:

Social Media Links:

Owners/Officers Name, Email, Cell Phone: *

Federal EIN: *

States Sales Tax Resale Number: *

General Manager Name, Email, and Cell Phone:

Accounts Payable Name, Email, and Cell Phone: *

Service Manager Name, Email, and Cell Phone:

Installation Manager Name, Email, and Cell Phone:

Sales Manager Name, Email, and Cell Phone:

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