MVNO Dealer Application: Step 1

Legal Company Business Name

This will be your corporation, LLC, etc.

Name of Parent Company, is Subsidiary

Name of Retail Location

Retail Location Store Number

Name of person completing this form for retail location

Company Contact

First Last

Email of person completing this form for retail location

Your Phone

Store Owner Name

First Last

Store Address

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

Business Phone Number

Number of Years in Business

Please enter a number greater than or equal to 1.

Website URL

Google My Business Listing

This is the local google reviews page for your business

Name of R2 Certified Battery Recycler

Name of Point of Sale System

Business Hours of Operation

Day	Open	Closed	Actions

There are no Days.

Wireless Consultant

A certified retail environment shall have a minimum of one Wireless Consultant onsite during posted hours of operation.

Name	Actions

There are no Consultants.