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Authorized Dealer - Copy 1

Sign Up To Be An Authorized Dealer
Supplier Name*
Contact Full Name*
Address*
Do you have a Website?*
- Yes
- No
Supplier Website*
Store Region*
- Africa
- Asia
- Australasia
- Europe
- North America
- South America
Customer Contact Number*
Customer Contact Email*
What describes your role(s)?*
- Tattoo Artist
- Piercer
How long have you been in the tattoo supply business?*
- 1-5 years
- 6-10 years
- 11-15 years
- 16-20 years
- 21+ years
Do you currently sell INTENZE?*
- Yes
- No
What are your current total annual sales?*
Where do you currently purchase INTENZE?*
Where will you be selling INTENZE?*
- Store Location
- Delivery Truck / Route
- Online Store
- Tattoo Conventions
- Catalog / Mail Order
What demographic(s) are you selling to?*
Forecasted annual INTENZE sales?*
Expected initial investment?
*
Method of Advertising?*
- Email Marketing
- Magazines
- Mailings
- Online Advertising
- Social Media
- Tattoo Conventions
- Website
How do you sell your product?*
- Delivery
- Phone
- Online Delivery
- Tattoo Conventions
- Other
Approximately how many tattoo shops are within a 100 mile radius of you?*
Approximately how many of those shops sell INTENZE?*
How many clients do you serve?*
Business References
Please enter up to 3 business references including company / shop name and contact phone number.
Business Reference 1*
Business Reference 2*
Business Reference 3*

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