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Reseller Application Form


This application is for initial authorization.
Please supply all required information. Incomplete forms may not be processed.
 

Contact Information :
Company:
 
Address:
 
City:
 
State/Province:
 
Country:
 
Zip/Postal Code:
 
Phone:
 
Fax:
 
Email:
 
Web Address:
 

 

 

Company Background :

 

Date Established: (mm/dd/yyyy)
At Present Location Since: (mm/dd/yyyy)
Your Location is a:
Related Companies:
Number of Additional Branches:
Number of Branches with Demo Facilities:
Type of Business: Direct Sales
National Reseller
Online Store
Educational Reseller
Top 5 Selling Products:
Industry Focus: Animation
Broadcast
Corporate Communications
Games
Post-production
Web


Personnel :

Total Number of Employees at all Locations:
Number of full-time Inside Sales people:
Number of full-time Product Support people:



Important: this is not an application form to become a Reseller with Di-O-Matic. It is a preliminary assessment form which will be used by Di-O-Matic to determine your ability to become a Reseller.


I attest to the accuracy of the above information :


Name:
Title:

 

Thank you for your interest in Di-O-Matic products.