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New Dealers

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 NEW DEALERS



Why be a CCI Product Dealer?

Join CCI's family of over 900 dealers, world-wide. Becoming a CCI Product Dealer is easy, simply fill out the forms, and submit for approval. Instructions can be found below.

Once you are our dealer, you can buy our products at wholesale to sell to your clients. You will have the advantage of having our unique and original products, that fill needs that other products do not. Our products are very reasonably priced and will add value to your sales.

As a CCI Mobility Dealer, you will also be listed on our web site (in the dealer locator section). When customers are interested in having our products installed locally, they will have your information readily available. We can also refer customers that call us to your company for their local mobility needs.

 


INSTRUCTIONS:
*Note: This form must be filled out completely.


To submit this form by Email:
    Dealer Forms Fill out New Dealer Form electronically
  1. Complete form (both pages) within Adobe Acrobat.
  2. Click the "Submit by Email" button (bottom of page 3).
  3. Attach a scanned version of your company's liability insurance certificate.
  4. In the email that is generated, type a list of certified technicians and authorized purchasers.
  5. Click "Send"
    (Outlook Users: Please remember to click the "Send/Receive" button if you are not configured to Send and Receive emails automatically).
To submit this form by Fax: [ method 1 ]
    Dealer Forms Fill out Form to Print and Fax
  1. Complete form (both pages) within Adobe Acrobat.
    *Note: A "Reset Form" button has been provided (bottom of page 3) to clear all information on the form, and provide a blank form for printing.
  2. Click the "Print Form for Fax" button (bottom of page 3).
  3. Include a version of your company's liability insurance certificate.
  4. Include a list of certified technicians and authorized purchasers.
  5. Sign and Date the Form.
  6. Include a Fax Cover sheet with contact information of the person who filled out the form.
  7. Fax all of the above to CCI (248) 577-0037 for approval.
To submit this form by Fax: [ method 2 ]
    Dealer Forms Printable New Dealer Form
  1. Click the "Printable Form (for Fax)" button (below).
  2. From Adobe Acrobat, select: File > Print.
  3. Complete form (both pages) manually... please print clearly.
  4. Include a copy of your company's liability insurance certificate.
  5. Include a list of certified technicians and authorized purchasers.
  6. Sign and Date the Form.
  7. Include a Fax Cover sheet with contact information of the person who filled out the form.
  8. Fax all of the above to CCI (248) 577-0037 for approval.

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