<%@ Language=VBScript %> <%option explicit%> Princeton Digital (USA) Corp. | Online Reseller Application

                

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General Information
Company Name:
 		Tax ID #:
Contact First Name:*
 		Contact Last Name:*
 		Title:
Street Address:
City:
 		State:
 		Zip:
Phone:*
 		Fax:
 		Email:*
Company URL:

Company Profile
Total Employees:
 		Sales Employees:
 		Technical Employees:
Who is your Primary Distributor?
 		Account number:
Who is your Secondary Distributor?
 		Account number:
Who is your Territory Distributor?
 		Account number:
Number of Sales Offices:
 		Locations:
Do you have a Storefront?
 Yes, No		 If yes, years in Business:
Approximately Annual Revenue:
 < $1 Million,  $1-5 Million, >$5 Million
Do you currently sell Princeton displays?
 Yes, No		 :
What other brands of display do you currently sell?
What percentage do you sell with a system?
 %		  
How many displays do you currently sell per month?
 15"     17"     19"    21"   Other  		 
Do you sell presentation products (i.e. Arcadia 36" display)?
 Yes, No		  
Would you like to be included in our lead referral program?
 Yes, No		  
Would you like to receive information and promotions via?
 Email, Fax		  
 

Your Target Market
Primary
Corporate  Education  Government  Small business  Home
Secondary
Corporate  Education  Government  Small business  Home
   
Signature (full legal name):*
 		 
Title:
 		Date:
 		 
   
 
 
 
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