*Contact Name:
*Company Name:
Address:
*Phone Number:
*Email Address:
Does your company resell office equipment?:	Yes No
In which country or territory do you plan to sell our products?:
¿Do you actually do technical support? (select all that apply):	Printers Copiers Computers Scanners Home Appliance
If you do technical support for equipment not listed on the last question, please list them here:
How many of your branch offices are capable of or have technical support?:
Where are those offices located? please indicate office area in metric or feet for each:
List the product brands you already sell:
List for which equipment models you have certified technical support employees:
How many employees do you have?:
Number of full time employees:
Number of full time Sales Reps:
Do you have on-site technical support services?:	Yes No
Do you have vehicles for on-site technical support?:	Yes No
What is the annual revenue of your company?:
List your Top 5 sales products and the percentage of each in your total sales revenue:
Business references:
Do you own the properties where your offices are located?:	Yes No
For how many years has your company been operating?:
Number of company's co-owners:
How many co-owners actually work in the company?:
Do you repair or service Delcop equipment to someone?:	Yes No
Are you in use of Delcop equipment? (be specific):
What is the main motive for you to fill this application form?: