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 NameLast Name
Business Name*
Contact Number*

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
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 monthsLooking to start in 6 monthsLooking to start in 12 monthsCurrently just researching for dealer opportunitiesReady 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