Authorized Seller Proposal Form

Please ensure your Authorized Seller proposal meets the following requirements:

Potential Authorized Seller Overview

Retail name of potential Authorized Seller partner:

Please enter potential Authorized Seller partner name

Type of store and services offered

Please enter store and services offered

Is this request actioning a Authorized Seller lead provided by your Director and/or DBM?

Please select actioning option

Total # of Retail Locations

Please select number of retail locations

Current operating market(s)

Please enter current operating market

Potential Authorized Seller Location Information

LOCATION 1

Street Address

Please enter street address

City

Please enter city

Unit

Postal Code

Please enter postal code

Phone Number

Please enter phone number

Mall Name

Store Hours

Monday

Please enter open and closing time

Tuesday

Please enter open and closing time

Wednesday

Please enter open and closing time

Thursday

Please enter open and closing time

Friday

Please enter open and closing time

Saturday

Please enter open and closing time

Sunday

Please enter open and closing time

Please upload image(s)

Please upload image(s)

Approx sq ft of the proposed retailer

Please enter approx sq ft

Confirm no branded/partner retailer within 1km

Exception is required

Potential brands and lines of business

Rogers

Fido

chatr

Wireless

Home

Please select a brand and list of business

Dealer information

Name of Rogers Dealer Principal:

Please enter name of principal rogers dealer

Rogers Dealer Principal Email:

Please enter email of principal rogers dealer

Potential Authorized Seller Principal:

Please enter potential principal sub-agent

Merchandise Language

Please select merchandise language

Proposed opening date

Please select opening date

Anything else you want the Authorized Seller committee to be aware of?

Please enter more details

Thank You

Thank you. We will book a follow-up meeting after the Authorized Seller Committee has reviewed your proposal.

UPLOADING FILE(S)