Smart Tint Authorized Provider

Please note that all information provided on this form is 100% confidential and will not be disclosed at any time to any 3rd party without your prior consent.

Contact Name (First, Last, Middle)

*

Email Address

*

Company Name

*

Company Website Address

What would you like your Smart Tint website URL to be? For ex. yourname.SmartTint.com

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Authorized Provider Webpage. Upon application approval we will build you a webpage authenticating your company as an authorized Smart Tint Provider. Your web page will contain up to 2 photos of your choice representing your company profile, your company contact info and a reciprocal link to your website (terms apply).

Attach Photo of Showroom (optional)

Attach Company Photo (optional)

Provider Access Code (optional)

Company Physical Address

*

Company Shipping Address if different than physical address

Company Phone Number with area code

*

Company Fax Number

Country

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Person of Contact Name (Leave blank if sames as CEO)

Person of Contact Phone Number with area code and ext.

Number of employees

Year Business Established

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Federal EIN Tax ID Number or VAT Number

*

State of Incorporation for USA applicants only

Distance willing to travel for job site installation

*

1-15 15-30 30-50 50-100 100+

Existing Vendor References, Certifications or Group Associations

Have you installed Smart Tint before?

Do you have a showroom?

If Yes, is it available

to the public by appointment only or both

General Comments or Requests

For which applications would you be interested in purchasing? (Check all that apply) *

Automotive

Residential

Commercial

Marine

Aviation

Custom Fabrication

Top Secret

Which Smart Tint Product are you interested in? (Check all that apply) *

Smart Cling™ Self Adhesive

Non-Adhesive

White-standard

Black

Grey

Blue

Yellow

Green

Pink(Salmon)

Control units

Dimmer Systems

Accessories

Estimated initial order (in USD)

*

What type of marketing do you do? (Select All That Apply)

Internet Search Engine Online Banner Ads Email Marketing Newspaper Magazine TV & Radio Yellow Pages Seminars Home Show Other

Would you like us to forward you Architect leads for potential projects and previous project viewings.

yes no maybe