ID-TECH DISTRIBUTOR APPLICATION FORM Legal Company

ID-TECH DISTRIBUTOR APPLICATION FORM
COMPANY INFORMATION
Legal Company Name:
Trading As (if different):
Company Registration Number:
Tax Registration Number:
VAT Registration Number:
Year Formed:
Registered Business Address:
Postal Address:
Telephone Number:
Fax Number:
Web address:
BUSINESS INFORMATION
Type of Business:
Owned by:
BEE Status:
Client Sector (Government/Private):
Local Offices:
International Offices:
Are any entities associated with your
company operating in competition with IDTech (Pty) Ltd?
Names of competitive entities:
Area of competition:
TECHNICAL EXPERTISE
Staff Component:
Number of Technical Staff
Number of Sales Staff
Number of Support Staff
Technical Expertise
Access Control
IT Networking
RFID Technologies
Project Management
Technical Support Capacity:
Call Centre
Mobile Technicians
Other Support
SALES FOCUS
Target Markets/Industries:
Target Client Sector
(Government/Private):
Access Control products currently
distributed/supported:
Years Experience:
Years Experience:
Years Experience:
Years Experience:
Yes
Yes
No
No
Training/Qualifications:
Training/Qualifications:
Training/Qualifications:
Training/Qualifications:
Details
Details
Current Annual Expenditure on Access
Control Products:
IT products currently
distributed/supported:
Current Annual Expenditure on Access
Control Products:
RFID products currently
distributed/supported:
Current Annual Expenditure on Access
Control Products:
ID-Tech Product Interest:
Estimated Annual Expenditure on ID-Tech
Products:
BUSINESS CONTACTS
Key Contact:
Title:
Telephone:
E-mail:
Sales Contact:
Title:
Telephone:
E-mail:
Technical Contact:
Title:
Telephone:
E-mail:
Accounts Contact:
Title:
Telephone:
E-mail:
REFERENCES
Client References:
1. Name, Contact Information
2. Name, Contact Information
Supplier Account References:
1. Name, Contact Information
2. Name, Contact Information
Permission to perform credit check:
Yes
No
APPLICATION INFORMATION
Completed By:
Title:
Statement of Confirmation:
Date:
Signature:
I hereby confirm that I am authorised to sign this form and that all information furnished in this
form is complete and accurate at the date of signature.