International Reseller Application

regions outside of the United States, Canada, and Australia

*All Fields are required

Company Name:

Web Address: www.

Contact Name:

E-mail Address:

Telephone Number (International):


City Name:

Postal Code:


How many years have you been in business?:

What is your reseller territory?:

Type of micrographic equipment installed in reseller territory?

Describe your micrographics sales and support capabilities