Distributor Qualification Form

At AlazarTech, we want to partner with technical distributors around the world to bring our low cost, high performance products to customers everywhere. If you feel that your company is well suited to becoming an AlazarTech distributor, please complete this form. Our international sales staff will be in touch with you shortly.

Your full name:
Company:
Your Job Title:
E-mail address:
Your Web Site:
Mailing address:
City:
State/Province:
Zip/Postal Code:
Country:
Telephone:
Fax:
Territory Covered:
Last Year's Revenue:
What are your Top 5 product lines?
Does Your Company have experience selling scopes or data acquisition cards?	Please list the scope or data acquisition manufacturer's names here
How many sales engineers do you have?
How many software engineers do you have?
What programming languages can your software engineers support?	Leave as is if you do not have software engineers
Where did you hear about AlazarTech?

www.alazartech.com