1-800-867-5968 |
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| Dynasys Technologies inc. 800 Belleair Rd. Clearwater, Florida 33756 | ||
|---|---|---|
|
DATACARD RESELLER APPLICATION |
Print out and send / FAX to Dynasys 1-727-443-4390 |
| Contact Name: | |
| Signature: | |
| Business Name (DBA): | |
| Address: | |
| City: | |
| State: | |
| Zip Code: | |
| Telephone: | |
| Fax: | |
| Email: | |
| Branch Locations: | |
| Date Business Started: | |
| Fed ID#: | |
| Reseller # | |
| Type of Organization: | |
| Corporation | Public Private State of Incorporation |
| Partnership | |
| Proprietorship | |
| Company Contacts | Name Title Phone/Fax |
| Marketing | |
| Sales | |
| Contracts | |
| Service | |
| Other | |
| Company Information: | |
| Please list the principals in your organization and their backgrounds or attach resumes: | |
| Name: | |
| Title: | |
| Brief Background | |
| Name: | |
| Title: | |
| Brief Background | |
| Name: | |
| Title: | |
| Brief Background | |
| Total Number of Employees: | |
| Estimated Yearly Sales Volume (in dollars): | |
| 1) 0 | |
| 2) $1 - $50,000 | |
| 3) 50,001 - 100,000 | |
| 4) 100,001 - 250,000 | |
| 5) 250,001 - 500,000 | |
| 6) 500,001 - 1,000,000 | |
| 7) 1,000,001 - 2,500,000 | |
| 8) 2,500,001 - 5,000,000 | |
| 9) 5,000,001 - 10,000,000 | |
| 10) 10,000,001 - 25,000,000 | |
| 11) 25,000,001 - 50,000,000 | |
| 12) 50,000,001 + | |
| Please Check all the Industry/Verticle Markets you sell to: | |
| Advertising/PR Firms | |
| Agriculture/Forestry/Fishing | |
| Architect/Engineering Firms | |
| Banking/Financial/Securities | |
| Business Services - other | |
| Communications (Phone, Radio,TV,Data) | |
| Construction | |
| Education (K-12) | |
| College (College/University) | |
| Government (Federal/Military) | |
| Government (State/Local) | |
| Hospitality | |
| Insurance | |
| Manufacturing | |
| Medical - Hospital | |
| Medical - Office | |
| Medical - Health Services | |
| Non-profit Organizations | |
| Public Utilities | |
| Real Estate | |
| Retail (auto,service etc.) | |
| Transportation | |
| Wholesale Distribution | |
| Other | |