Reseller Interest Form

Please fill out and submit the Reseller Interest Form. We will contact you shortly, regarding our requirements, pricing, and the support tools we provide.

To expedite the new account process, please feel free to fill out the Credit Application.We also accept Visa, Master, American Express, and Diners Club for immediate processing of your order.

You can fill it out online, then print it out, and mail it to us at the address noted on the form.

Thank you for your interest.

New Business Development
SpecTech, Inc.

Reseller Interest Form
     
Company Name:  
Year Established:  
Contact Person's Name:  
Address:  
City:  
State/Province/County:  
ZIP or Postal Code:  
Country:(*Postal Code is Required)  
Day Phone:  
Evening Phone:  
Fax:  
Email:  
Website Address:  
     
Check all that apply:  

Distributor
Dealer
Online Store
Re-Distributor
Retail Chain
Convenience Store
Manufacturers Rep
Other:

     
Geographic Area:  
Number of Sales Associates:  
Number of Locations:  
Number of Years Distributing:  
Annual Sales:  
     
How did you learn of this product?  
     
Any additional comments you'd like to add: