Dealer Price List Request Form

CPR Technology

Company Name:
*

Name:
*

Job Title:

Address:
*

State:
*

Zip:
*

Country:

Phone:
*

Cell Phone Number:

Fax Number:

Email:
*

City:
*

Seller's Permit Number:
*

Monthly purchase forecast:

What wholesalers do
you buy from now:
*

How many retail stores to you have:

If you sell Nextel Accessories on the internet, what is your domain name:

How many years have you been in business:
*

Please select one of the following: *

Nextel Dealer

Nextel Master Agent

Nextel Employee

Retail Store

Comments:

		The process is not yet complete. Please remember to FAX your Sales Tax or Seller's Permit to (718)-623-3018 to complete the registration process.
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CPR Technology • 640 Dean Street • Brooklyn, NY 11238 • 877-277-5237 • Contact Us