Dealer Application

MIWD Prospective Dealer Profile Form

Please fill out the form below as completely as possible. The information will help our sales team to better evaluate the opportunity to work together. A member of the sales team will contact you after you submit the form. Please note that this is not an application for terms or credit.

*Contact Name		*Company Name
DBA
*Street		*City
*State		*Zip
Mailing 1		Mailing 2
Mailing City		Mailing State
Mailing Zip		Mailing Zip Plus 4
*Phone		Fax
*Email		Web
Facebook		Twitter
YouTube		*Annual Overall Sales
*Annual Window Sales		*Showroom Size
*Number of Locations		*Number of Salespeople
*Number of Installers
*Window Supplier #1		Window Supplier #2
Window Supplier #3		Window Supplier #4
Window Supplier #5
*Window Supplier #1 Volume		Window Supplier #2 Volume
Window Supplier #3 Volume		Window Supplier #4 Volume
Window Supplier #5 Volume
Comments/Notes
	* Indicates required field