Eurocom Dealer Application

Dealer Application

If you would like to become a Eurocom Dealer, please submit this application.
To be able to order Eurocom systems online, you need to be an active Eurocom Dealer. Please contact us at sales@eurocom.com or call 1-877-EUROCOM (387-6266) x 1 / 613-224-6122 x 1.


*Legal Company Name:		Corporate Number:
Dun & Bradstreet#:		PST# (Ontario):
EIN (US)/ VAT ID (EU):		*Country:

*Address:		*City:
*Province/State:		*Postal/Zip Code:
*Phone:		Fax:

Main Contact - Sales Manager or Purchaser:
*First Name:		*Last Name:
*Email:

Marketing Contact:
First Name:		Last Name:
Email:

Service & Support Contact:
First Name:		Last Name:
Email:

Accounts Payable Contact:
First Name:		Last Name:
Email:

Website:		Your Eurocom Sales Rep:

*Business Type:		*Operating Since:
Revenue (Last Fiscal Year):		*Number of Employees:
*Number of salespeople:		*Do you sell Notebooks now (What Brands):
Notebook Sales/month in $:		Notebook sales/month in units:
*Do you carry Demos:		*Do you have a Demo showroom:
*Location size (sq.ft):		How did you hear of us:
Do you Advertise:		If yes, What Publications:

* - required fields