MVM Affiliate Page

M.V.M. - AFFILIATE APPLICATION

Important note to all AOL users: This form is not currently functional inside AOL. In order for the information to transmit properly, you will need to either use a browser outside of the AOL program (i.e.: Internet Explorer or Netscape), or send an email to Locksmith@MVMLocks.com expressing an interest in the Affiliate Program (Please include you Name, Company Name, Address and Contact Information).

Business Information

Company Name:*

Address 1:*

Address 2:

State:

(Note: Currently we are only accepting affiliates in NY State. Our Tri-State Area Affiliate Program will be taking effect in mid 2003)

Zip Code: *

Owners' Name:*

(first name) (last name)

Locksmith License #:

- If applicable

Insurance Information:*

Insurance Company:
Type Of Insurance:

Years In Business*	Hours Of Operation*	Mon-Fri
		Sat
		Sun

# of Locations*

# of Employees*

Are you willing / able to take off-hour (emergency) service calls? *	Yes No
(note: In order to be the exclusive affiliate for any area, you must be able to handle emergency service calls)

In addition to standard locksmithing, what other areas of security does your company specialize in?

Access Control Systems	Biometrics
Cameras and Surveillance	Key Control Systems
Safes (Sales and Service)	Specialty Keys (Miwa, Dom, Fichet, etc.)

Primary Contact Information

Primary Contact :*

(first name) (last name)

Phone Number :*

Alternate Phone #:

E-Mail Address

Locksmith License : *

Available Hours :*

Mon-Fri	to
Sat	to
Sun	to

Secondary Contact Information

Secondary Contact :*

(first name) (last name)

Phone Number :*

Alternate Phone #:

E-Mail Address

Locksmith License : *

Available Hours :*

Mon-Fri	to
Sat	to
Sun	to

Note: Fields marked with * are required