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 Dealer Application

Privacy note: We value your privacy and handle your information confidentially. It is used only by backbone, Inc. for processing your dealer application and will not be shared with any third party. If for any reason the application is rejected, we delete all the information upon your request.

Fields marked with (*) are required for submission. For a successful on-line application, we suggest you fill out all applicable fields. We may contact you for further details and to provide you with more information on backbone dealership.

Please confirm the information you fill in the form, if you want to change or add,please click on the "back" button.

1 of 3: Contact Information
Salutation:	Mr Ms
*First Name:
*Last Name:
*Title:
*Company Name:
*Compay Address:
*City:
*State/Province:
*Zip/Postal Code:
*Country:
*Phone:
* Fax:
*E-mail:
Website URL:

2 of 3: Organization Details
Date Business was Established:
Number of Employees:
Estimated Annual Gross Sales:$

3 of 3: Details of Current Activity
What percentage of your current client base comes from the following?
Wholesale: %
System Design and Install: %
Retail: %
How did you hear about backbone?
Have you used the backbone products before?	Yes No
How do you plan to market or sell the backbone Products:
What Geographical area(s) does your company cover?
Do you provide on site installation service?	Yes No
Do you provide Phone support?	Yes No
Request information (detail what kind of support you need to market or sell backbone products):

1 of 3: Contact Information
Salutation:
*First Name:
*Last Name:
*Title:
*Company Name:
*Compay Address:
*City:
*State/Province:
*Zip/Postal Code:
*Country:
*Phone:
* Fax:
*E-mail:
Website URL:

2 of 3: Organization Details
Date Business was Established:
Number of Employees:
Estimated Annual Gross Sales:$

3 of 3: Details of Current Activity
What percentage of your current client base comes from the following?
Wholesale: %
System Design and Install: %
Retail: %
How did you hear about backbone?
Have you used the backbone products before?
How do you plan to market or sell the backbone Products:
What Geographical area(s) does your company cover?
Do you provide on site installation service?
Do you provide Phone support?
What Geographical area(s) does your company cover?
Confirmation code: Please type in the text you see into the field above. This prevents fraud.

• gk@bkb.cn
• wmy@bkb.cn
• wmy0705
• jenny.lanlan