Dealer of Record

Distributor Information
All fields must be completed in order for the form to be submitted.
Company Name*
Name*
First Last
Email*
Office Phone*
Cell Phone*
Client/End-User Information
Department or Military Unit*
Point of Contact*
First Last
POC Address*
Street Address City State / Province / Region ZIP / Postal Code Country
POC Email*
POC Phone*
Opportunity Information
Please provide a brief synopsis of the items discussed with the client.
Potential Quantity*

Enter Numeric Values only
List all of the products and training services from Tactical Electronics that were discussed with the client.*
Description of Work Completed to Support DOR Request:*
ALL FIELDS MUST BE COMPLETED IN ORDER FOR YOUR FORM TO BE SUBMITTED SUCCESSFULLY. The DOR Program is designed to reward Distributors who are aggressively demonstrating and promoting Tactical Electronics products and services to generate new business. A Tactical Electronics representative will respond to your request as soon as possible, usally within 2-3 business days.
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Distributor Information