Integrated Total Plant Design Solutions

RESELLER APPLICATION FORM

 
   
 
 
 

We are pleased that you are interested in becoming a reseller of ImageGrafix. To get started, simply fill out the request form and we will send you the reseller agreement and discount information.


  Company Information:

 
Organization:*
Address:*
City:*
Country:*
Telephone:*
Fax:
E-Mail:*
Web Site:
 
Administrative Contact:
  Name:*
  Telephone:
  E-Mail:*
 
Sales & Marketing:
  Name:*
  Telephone:
  E-Mail:*
 
Billing Contact:
  Name:*
  Telephone:
  E-Mail:*
 
Business Data:
 
Type of Business:*
Profile of clients (Industry, size, etc.):
Geographical area served:
% of revenue from software sales:
% Revenue from hardware sales:
Anticipated sales of ImageGrafix Products and Services:*
 
Trade References:
 
Firm Name & Account Number:
Address:
Contact Name:
Telephone:
 
Bank References:
 
Bank Name & Account Number:
Address:
Contact Name:
Telephone:
 

                    

 
 

 

 
 
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