NiveusMedia, Inc.

Niveus Authorized Dealer Inquiry Form

Apply to become a member of the elite Niveus Authorized Dealer Network. Please complete the following form and a Niveus representative will follow up with you.

Niveus Media is committed to its Authorized Dealer Network. From access to exclusive products made available only to Authorized Dealers, to Profit Margins that will help your business grow, Niveus Media will support you as you expand your product offering to include the Niveus' award winning line of high-end media center systems and storage server products.

Company Name

Year Established

Street Address

Suite, Apt. #

City

State

Zip Code

Phone

Fax

Email

Company URL

Tax ID#

Key Contacts

Primary Executive Contact

Title

Name

Email

Phone

Fax

Yes No - Do you have a storefront or showroom?

Yes No - Do you offer home installation services?

Yes No - Are you a CEDIA member?

Please briefly describe your core business and market:

What other Product Lines do you carry?:

Comments: