Dealer application form

Company information

Company business name

Mailing address (street, city, state/province, Zip/postal code, country)

Shipping address (if different from above)

Telephone number (include country code, area code)

Fax number

Cell or GSM number

E-mail

Website address (URL)

Contact information
For the primary contact person

Contact name

Position in company (owner, president, head laser operator, etc.)

Company background

How long in business

Number of people in company (full-time or equivalent)

Number of sales people in company

Geographical business area

What facilities and equipment do you have for demo purposes?

Brief history of company

Pangolin experience

How many Pangolin systems are used at your company, or by your employees?
        LD Pro      None   1   2   3   4   5+
        LD Basic   None   1   2   3   4   5+
        LD Intro    None   1   2   3   4   5+

Primary Lasershow Designer users in your company

        User 1:
        Experience level:   Beginning   Intermediate     Advanced
        Percent of work time using LD:   1-25%   25-50%   50-75%   75-100%

        User 2:
        Experience level:   Beginning   Intermediate     Advanced
        Percent of work time using LD:   1-25%   25-50%   50-75%   75-100%

        User 3:
        Experience level:   Beginning   Intermediate     Advanced
        Percent of work time using LD:   1-25%   25-50%   50-75%   75-100%

 Do you or your staff request additional training in LD?
      Yes     No

Describe your main market and customers

Approximate annual gross sales (in US dollars)
$USD

List the percentages of each activity in your business (should total 100%)
      %  Laser installations (long term)
       %  Laser shows and productions (short term)
       %  Laser rentals
       %  Laser/optical equipment manufacturing
      %  Video production
       %  Computer graphics/animation production
      %  Lighting equipment
       %  Sound equipment
      %  Other
       (Total = 100%)

List the percentages of total advertising/promotion budget (should total 100%)
Print advertising:
       %  Local publications
      %  National publications
       %  International publications
Non-print advertising and promotion:
      %  Non-print media (radio/TV/billboards, etc.)
       %  Trade shows attended as exhibitor
      %  Website/Internet
       %  Other
       (Total = 100%)

List trade shows attended as exhibitor (your own booth or shared booth)

List trade shows attended as non-exhibitor (booth support, attendee)

 What are your estimated sales for the next 12 months?
      LD Pro      None   1-2   3-5   6-9   10+    
      LD Basic   None   1-2   3-5   6-9   10+
      LD Intro    None   1-2   3-5   6-9   10+
      ADAT systems   None   1-2   3-5   6-9   10+   

Project references  

List up to three installations, shows or projects where you have had significant responsibility. Describe your laser-related contributions, and provide a contact whom we can reach if more information is needed.

Installation/show/project reference 1
        Project 1 name 
       
        Project 1 description
       

        Contact name
       
        Contact telephone number (include country code, area code)
       
        Contact fax number
       

Installation/show/project reference 2
        Project  2 name 
       
        Project 2 description
       

        Contact name
       
        Contact telephone number (include country code, area code)
       
        Contact fax number
       

        Project 3  name 
       
        Project 3 description
       

        Contact name
       
        Contact telephone number (include country code, area code)
       
        Contact fax number