Activate Your Flagship Selling Center

Name*

First Last

Email Address*

Please Submit 1 Form per Location / Selling Center

If you have more than one location, please submit a new form with that locations information for EACH selling center purchased and received. This form must be submitted to have the dealer listed as a flagship on Goldentech.com

Who is filling out this form? (Name / Title)*

Account Number*

Company Name*

Owner Contact Name*

First Last

Owner Contact Email*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Phone*

Company Fax

Number of Locations*

(Please fill out one form for each location)

Company Owner

Owner Email

Manager Name

Who is your Golden Sales Representative?

Company Website

E-Mail Contact for Dealer Locator Listing*

Which Type of Flagship Selling Center Are You Activating?*

Lift Chair
Mobility

Has the Lift Chair Flagship Selling Center been received on site?*

Yes
No

*Please note: When new fabrics are introduced, you will receive swatches free of charge as part of a selling center update kit. There is a cost for all replacement swatches.

Have the employees received Lift Chair Sales training via Sales Representative?*

Yes
No

How many lift chairs are floored currently?*

Enter the number below.

Which Lift Chair Flagship Level did you Agree to become?*

Level 1: 1-4
Level 2: 5-11
Level 3: 12-23
Level 4: 24+

Do you floor Twilight chairs?*

We will verify with your order history.

Yes
No

Will you floor Twilight chairs?*

Yes
No

Has the Mobility Flagship Selling Center been received on site?*

Yes
No

Have the employees received Mobility Sales training via Sales Representative?*

Yes
No

Are Golden Mobility Products floored?*

Scooters
Power Wheelchairs
None

How many scooters are floored?

How many power wheelchairs are floored?

Which Mobility Flagship Level did you Agree to become?*

Level 1: 1-4
Level 2: 5-8
Level 3: 9+

Do you offer CareCredit consumer financing?*

Yes
No

Are you a Golden Service Dealer?*

Yes
No

Has anyone "in-house" attended a Golden tech service training?*

Yes
No

Do you provide repair service to the public or in-house service only?*

Public
In-House Only

Please Upload a Photo of the Mobility Flagship Selling Center*

Max. file size: 20 MB.

Please Upload a Photo of the Lift Chair Flagship Selling Center*

Max. file size: 20 MB.

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