Reseller/Distributor Program:

If you would like to become an authorized reseller/distributor of Security Manufacturing Corporation products, please fill out the online form below and we will contact you soon.

Thank you and we look forward to a mutually beneficial relationship with you!

* Required Fields

Contact Information

Salutation:
* First name :
* Last name :
Title :
* Company name :
* Street Address :
* City :
* State/Province :
* Country :
* ZIP/Postal Code :
* Phone :
Cell/GSM :
Fax :
* E-mail :
Company URL :

* FID (Tax ID number for shipping purposes, U.S. only) :

D&B number (North America only):

* Have you spoken with a SMC representative:

	No
	Yes

If "yes", enter the name of the representative:

* Where did you hear about us?

If 'other', please describe:

* Please select the closest major city area near you.

Number of employees

How many employees are in your Organization/Company? :

In the Sales Department? :

In the Technical/Support Department? :

* When did you start your business?

Please provide a SMC specific sales forecast (per quarter and per year)

Describe current SMC sales opportunities

Indicate which of the following methods you use to attract new business

	Retail Store
	Web
	Yellow Pages
	Other

* How many customers do you have?

Please provide us with 3 references.

Name:
Title:
Company:
E-mail:
Phone #:
Relationship:

Name:
Title:
Company:
E-mail:
Phone #:
Relationship:

Name:
Title:
Company:
E-mail:
Phone #:
Relationship:

SMC Products

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