NEW DEALER INTAKE FORM Company InformationBusiness Name(Required)Primary Contact Name(Required)Title / RolePhone(Required)Email(Required) Webiste URL(Required)Years in BusinessBusiness Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business ProfileType of Business (check all that apply): Remodeling Contractor Remodeling Contractor Window & Door Dealer/Lumberyard Screen Room / Sunroom Installer General Contractor Other:Service Area (cities/counties served):Do you have an in‑house installation team? Yes No Do you currently offer porch enclosure or window systems? Yes No Product & Installation ExperienceIf yes, which brands/products?Average number of porch/screen projects per year:What prompted your interest in the Expanse porch window system?Showroom & DisplayDo you have a showroom or display area? Yes No Are you interested in adding an Expanse display? Yes No Possibly — need more info Sales & MarketingWould you like to receive homeowner leads from our dealer locator? Yes No Do you want to be listed on Porchwerx.com as an authorized dealer? Yes No Do you currently use digital marketing or social media? Yes No If yes, what platforms do you currently useDo you plan to: Order per project Keep inventory on hand Not sure yet If different from above, who should we contact for orders, quotes, and support?NamePhoneEmail
