The Rosen TEAM thanks you for your interest in becoming a ROSEN International Distributor. Completing this form and submitting to Rosen is the first step in the process. Please complete all required data fields as any incomplete submittal will delay processing of your request. Once received, ROSEN's International Sales Manager will review the information and contact you about becoming a member of our rapidly growing Rosen family of Authorized International Distributors. Completion of this questionnaire does not automatically qualify you to become a Rosen Authorized Distributor as additional reviews will be required.
Distributor Name:
Street Address:		Unit #:
City:		State:		Zip:
Country:
Phone #:		Fax #:
Your Name:		Title:
Email Address:
Best time to call:
Years In Business:	Less Than One 1 2 3 4 5 6 or More	# of Locations:	1 2 3 4 5 6 or More
# of Employees:	1-2 3-4 5-9 10-24 25+
Countries You Distribute To:
Distribution Channels: (check all that apply)	OEM / OES		Car Importers
	Car Dealers		12V Specialists
	Mass Merchandiser / Retail Chain
Other (explain:)
Business Mix (estimate the percentage of business for each product listed to total 100%)
% Mobile Video Systems		% Audio Systems
% Navigation Systems		% Alarms
% Automotive Accessories		% Other (describe)
If Currently Distributing Mobile Video Products Please Answer These Questions
What brands do you distribute?
How many total mobile video monitors/systems do you sell monthly?	Complete the detailed section as follows:
	# Overhead Systems w/ Remote Source Unit
	# Overhead All-In-One Systems     (Monitor and source unit in one overhead pod)
	# In-Dash Systems
Describe the most popular system distributed by your company (include manufacturer name, screen size and other key information) :		Unit Sales Per Month	1-4 5-9 10-24 25+
	*** Thank you for your interest in ROSEN mobile video products!! ***