Dealer Partner Program Registration Form
 
 
To register, you MUST have a purchase account with an authorized EverFocus Distributor partner.
 
Company & Contact Information Date:
           
  Main Contact: Title: Phone: Email:  
         
  Additional Contact: Title: Phone: Email:  
         
  Additional Contact: Title: Phone: Email:  
         
     
 
Company Name:
 
     
  Address:  
     
 
City: State: Zip Code:
 
     
 
Phone: Fax: Website:
 
     
 
No. of Employees: No. of Office Locations: Product of Interest:
 
     
 
Do you work with an A&E Firm?      If yes, name of A&E Firm:
 
     
Additional Information:
What product(s) does your company currently sell and/or install? Check all that apply
 
 
 
Does your company have experience in IP video surveillance?
 
Does your company have experience in Analog CCTV systems?
 
Does your company have experience in Access Control systems?
 
 
Which end-user market does your company specialize in? Check all that apply
 
 
 
 
 
 
Distributor Information
Please list your top three preferred distributors:   account #
     
First:  
     
Secondary:  
     
Third:  
     
How did you hear about the EverFocus Dealer Partner Program?
     
 
 

Dealer Partner Program Terms and Agreements:

I understand the above terms and agreements

 

Print Name:

Title: Date:

 
     
 
www.everfocus.com EverFocus CA: 1801 Highland Ave. Unit A, Duarte, CA 91010 | Tel: 626.844.8888 | Fax: 626.844.8838