Dealer Application

We are seeking committed partners who can provide good sales and after sales service support for our products in their respective markets as dealers.

If you wish to become one of our dealers, please let us know more details about your organization and specific interests in our products by filling out the dealer application below. This helps us to learn more about your company especially the present range of your activities and those manufacturers and product lines you presently represent. Upon receipt of your completed application we can best advise how we can proceed.

Privacy note: We value your privacy and handle your information confidentially. It is used only by XISICO USA, 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 to fill out all applicable fields. We may contact you for further details and to provide you with more information on XISICO USA dealership.

1 of 3: Contact Information
Name: * Mr.  Ms.
Title: *
Organization: *
Address 1: * Address 2:
City: *
State/Province: *
Zip/Postal Code: *
Country: *
Phone: * Fax:
Email: *
Website URL:

2 of 3: Organization Details
How did you
hear about us? *
  Please specify:
Type of Business: *
Year Established:
Federal Tax ID #:
Estimated Annual Sales Revenue:
# of Employees:
Products you are selling now:
Do you provide repair service? Yes  No
Products you are interested in: Scopes Spotting Scopes Binoculars Mounts
Other, please specify:

3 of 3: Credit References, Trade References Are Preferred
Reference 1: Reference 2: Reference 3:
Company:
Address:
City:
State:
Zip Code:
Contact Name:
Phone:
Fax:

Additional Message to the Application
Additional Message:
 
  

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