Segway-Ninebot Service Agent Application Form
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Email address *
Name of company: *
Your answer
Your name: *
Your answer
Website URL:
Your answer
Your Location: Suburb *
Your answer
Your location: State *
Your answer
Do you have a brick and mortar store? *
Are you open to selling at least three of our products? (if "No", skip the next question) *
If answered yes above, which product would it be?
Do you have any comments or questions?
Your answer
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