ClearBlueHawaii.com

Dealer/Representative Application

All sections that have an asterisk* next them are mandatory.

Company *	:
First Name *	:
Last Name *	:
Email *	:
Address *	:
City *	:
State	:
Foreign Province	:
Country *	:
Zip Code *	:
Phone *	:
Fax	:
Mobile *	:

Type of Business *

Number of Store Front Locations *

Number of Employees *

Do you have warehousing capabilities? *
YesNo

Warehouse Sq. Footage *

Product Lines Past/Present *

Total Number of Dealer Accounts *

Gross Annual Revenue *

Products of Interest *

QTY *

How did you hear about Clear Blue Hawaii? *

Who referred you to our website? It is important for you to tell us who referred you to our site so that your friend / family get credit for the referral. Email address of the friend that referred you to our site.

Email address of the friend that referred you to our site.

Do Do you have a friend or an associate that is either a dealer or a rep? If you do send them our way and we’ll add an additional 10% off your next order.

Did you refer your colleagues, friends and family? * YesNo

POST US ON YOUR WEBSITE / SOCIAL NETWORKING / BLOG - By posting us on your website / social networking site / blog & referring us to all your friends on your list you will be posted on our website as a rep/dealer, you’ll be featured on our Newsletter, and you’ll receive 250 entries into the Clear Blue Hawaii Contest. In the event that any of your friends win our contest you will also win (one Clear Kayak for your Friend and one for You). All you need to do is provide a link where you posted our website.
Clear Blue Hawaii website location: http://www.clearbluehawaii.com

Did you email your list of friends and post our website on your community site / blog? * YesNo

Link to posting on your site (Copy & Paste):

By downloading our free screen saver you will also be eligible to win the Molokini 2 Person Clear Kayak “fully loaded”. This will include ergonomic seats, and fiberglass paddles. The screen saver updates weekly with relaxing vibrant new images of exotic fish and beautiful tropical locations.

| Download Free Screen Saver |

What is the best time to reach you? *

What is the best day to reach you? *

Did you download our free screen saver? * YesNo

Subscribe to our monthly newsletter and receive updates on all our future contests, events, innovative products, and existing new free downloadable gadgets & gizmos. *
YesNo

Questions & Comments

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