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Retailer Application Form

BUSINESS INFORMATION

Business Name (Required):

*

DBA (if Different) (Optional):

Contact Name (Required)

*

Email (Required):

*

Phone (Required):

*

Store Address (Required):

*

City (Required):

*

State (Required):

*

Zipcode (Required):

*

LOCATION INFORMATION

How Many Locations Do You Own?

*

How Many Locations Do You Own?

A

1 Location (Independent)

B

2-3 Locations

C

4-5 Locations

D

6+ Locations

CHOOSE YOUR TIER

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Trial Retailer (25 units @ $12.50/unit = $312.50)

*

Early Retailer (50 units @ $11.50/unit = $575.00)

Launch Partner (100 units @ $9.99/unit = $999.00)

Payment preference:

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50% deposit now, balance Net 15

*

50% deposit now, balance Net 30

Pay in full (priority fulfillment)

ADDITIONAL INFORMATION

How did you hear about CloudTrack?

*

How did you hear about CloudTrack?

A

Email outreach

B

Phone call

C

Referral

D

Social media

E

Industry event

Are you ready to order now or exploring options?

*

Are you ready to order now or exploring options?

A

Ready to order immediately

B

Need more information first

C

Planning to order

Special requests or questions:

*

I agree to CloudTrack's Retailer Terms and Conditions

*

I agree to CloudTrack's Retailer Terms and Conditions

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