The information provided in this application, allows us to profile your company and provide you with the tools you'll need to support DIAMONDSCAN software and grow your business.

This application is designed to give us a better understanding of your business. The time you spend completing this form will be well spent. Please provide us with all the information requested to ensure your application is processed promptly.

Confidential information provided to us will not be released to any other party.
ABOUT YOU:
YourName
Your e-mail
 
BUSINESS NAME:
Business Name
Address
Website
 
e-mail
  Fax
 
CONTACTS:
President/ Owner
Name
Title
Telephone
Ext.
e-mail
  
 
Primary Contact
Name
Title
Telephone
Ext.
e-mail
  
 
Sales Marketing Contact
Name
Title
Telephone
Ext.
e-mail
  
 
Technical Contact
Name
Title
Telephone
Ext.
e-mail
  
 
TYPE OF BUSINESS:
Corporation Subsidiary Partnership Sole prop
       
SALES VOLUME:      
Less than $500,000 $500 to $999,000 $1 to $5 million  
Over 5 million Over$10 million Over $25 million  
       
EMPLOYEES:
Please indicate the number of Employees dedicated to Point of Sale (CONFIDENTIAL)
POS Sales POS Support Other  
 
CUSTOMERS:
 Which of the following best describes your customer base?
1 to 3 Lane Grocery Store 3 to 5 Lane Grocery Store
More than 5 Lane Grocery Store Convenience Store
Convenience Store w/ Gas Hospitality
General Merchandise  
       
PRODUCT TYPE:
 Which best describes the products you sell.
Cash Registers PC Based POS Systems
Propriety POS Systems Convenience Store
       
PRODUCT LINES:
 If you listed PC based or Proprietary POS systems above, please list the products your company is currently selling or has sold, and supports.
Product Years Sold Installations
1.
2.
3.
4.
     
PLATFORMS:
With 1 being weak and 5 being strong. How would you rate your strength in the platforms which your company has experience with:
 
STRONG --
5 4 3 2 1
--WEAK
Win 95/98
  
Windows NT
  
Novell
  
Other
 
 
POS EQUIPMENT:
What lines of POS equipment to you currently support ?
 
TERRITORY:
 In which country, state(s) / province(s) and cities, do you focus your sales efforts?
Country
States/ Province
Cities
   
MARKETING:
What marketing efforts does your company use to reach its target market?
 
REFERENCES:
Please provide us with 3 client references.
Company Contact Telephone
1.
2.
3.
     
GENERAL INFORMATION:

Please tell us anything else about your company that could help us serve you better.

                

 
1-800-278-2701