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#: P.S.T # (Ontario):
Tax ID Number (US)
VAT ID Number (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
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