REQUEST AGREEMENT FORM

Interested in becoming an authorized dealer for anthem? If so, please take a moment to fill out the form below.
A member of our sales team in your local market will reach out to you within 5-10 business days.

Request Dealer Information

Become a anthem Dealer

Title of Principle

First Name of Principle*

Last Name of Principle*

Date Business Commenced*

Company Name*

Ownership Type*

Proprietorship

Partnership

Incorporated

LLC

Phone Number*

Company Email*

Company Website URL*

Total Annual Sales*

Number Of Employees*

Percentage of Annual Sales Related to Audio*

Other Authorized Speaker or Subwoofer Brands*

If other authorized speaker or subwoofer brands are not listed, start typing the name and hit create.

Other Authorized Electronics Brands*

If other authorized electronics brands are not listed, start typing the name and hit create.

Control/Automation Brands*

If Control/Automation Brands are not listed, start typing the name and hit create.

Address Information

Street*

Unit

Country*

State/Province*

City*

Postal Code/Zip Code*