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Dealer Form


If you wish to become a Medialon Value Added Reseller (VAR), we kindly ask you to fill in this online form. This will be for Medialon internal use only.

The better we know you, the better we can serve you !
 
  
General Details  
Name *
Job Title
Company *
Address
Zip Code City 
State
Country *
Tel Fax 
Email *
Website
  
  
Business Details  
Years in Business *
Average Revenues *
Owner Name *
Number of Field Technicians
Number of Sales Representatives
Number of Programmers
  
  
Certifications  
Company and/or Employees'
Certification(s)
  
  
Products Sold  
Control System
Video Projector
Video Server
Lighting Equipment
Audio Processing and Amps
Other(s)
  
  
Business Activity  
Percentage of your business per market:
     
Corporate % *
Board room % *
Museum % *
Education % *
Hospitality % *
Staging % *
Entertainment % *
Place of Worship % *
  
Percentage of your business done by:
 
Visiting customers to find jobs % *
Answering bids % *
Being involved in design-build % *
  
  
  
Additional Information
If you are applying to be a Medialon VAR for a specific project or if there is any additional information you would like us to know about your company, please add your comment below.