Authorized Reseller Application
3680 Willshire Blvd P04-1546 Los Angeles, CA 90242 www.liberatedeyewear.com
Name
First Name
Last Name
Position/Title
Department (optional)
Company Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Website URL (optional):
How long have you been in Business?
How man location do you operate? (Please provide addresses for each location.)
What is the primary focus of your business? (e.g.,retail eyewear sales, eye exams, contact lenses, etc.)
What other brands of eyewear do you currently carry? (list at least 3 companies)
Who is your target demographic? (e.g.,age group, income level, lifestyle)
What is the percentage of your customer base is repeat customers?
What type of eyewear are you looking for? (choose all that apply)
Luxury
Spectale
Mid luxury
Children
Sports
Women's eyeglasses
Men's eyeglasses
Sunglasses
How did you hear about us?
Referral
Direct Mail
Online Add
Sales Call
Print Ad
Other
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