Dealer Registration Form

Get Qualified to become an AXIM Dealer

Please provide all required details below to qualify your business with us. If your company qualifies to become an AXIM dealer, we will be in contact with you to discuss further opportunities.
Primary Contact *

First Name Last Name
Business Name *
Contact Number *

Area Code Phone Number
E-mail *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Type of Business *
Please provide a short description about your company. *
Please describe your current interest level in becoming an AXIM Dealer.

Looking to start selling in in the next 3 months Looking to start in 6 months Looking to start in 12 months Currently just researching for dealer opportunities Ready to buy today
What market do you service? What is your geographic reach?
What is your annual sales volume?
How many sales people do you have on your team?
Should be Empty:

Get Qualified to become an AXIM Dealer