Distributor Referral Form - National Retail Solutions

REFERRING A BUSINESS IS SIMPLE:

Complete this form with the name and contact information for the business you want to refer. Make sure to include your information, so that you’ll get the credit.
After you fill out the form, we will get in touch with the business you are recommending and speak with them about the advantages of our POS.
If our solutions are a fit for the business’ needs, we will have someone come in and install their new point of sale (POS) system.
After the business has the POS for sixty days, you’ll receive your commission.

Enter Your Information
Name*
First Last
Your Phone Number*
Your Email*
Name of Your Business
Your Address*
Street Address Address Line 2 City State ZIP Code

NOTE: Please include an accurate address including city, state and zip.
Referred Business Info
Business Store Name*
Business Owner Name*
Business Owner Phone Number*
Business Owner Email