If you are a company and would like to be qualified as a reseller/System Integrator/distributor and/or receive quantity pricing for your business needs, please fill out this online application and fax a copy of your business license (and your state resale license if you are reselling) to (714)546-3418.  You can skip the EIN and State Resale Number if you are located outside of the United States.  One of our account managers will contact you as soon as we received all the required information and documentation.

*This application must be completed in full.  Incomplete applications will be rejected.  Completion of this application does not imply that you have been accepted as a XENARC Authorized Reseller/Distributor.

Company Information:
 

*Company Name:
Federal Tax ID (EIN):
State Resale Number:
*Contact Name:
Contact Title:
*Company Address:
*City:
State:
Zip Code:
Country
*Tel #:
Fax #:
*E-mail:
Website URL:

Company Background:
 

Type of Ownership::
*Year Established:
*Number of Employees:
*Annual Revenue:
Purchasing Agent:
AP Contact:
Owner/President:
Partner/VP:

Nature of your business:
 

	Traditional Reseller		Wholesaler		System Integrator
	Internet Reseller		Distributor		Manufacturer
	Value Added Reseller		Importer		OEM / ODM
	Other:

Please Specify which products interest you (check all applicable):

7" TFT LCD Monitors		8" TFT LCD Monitors
	700Y		800YV
	700TSV		800TSV
	700IDT		805TSV
	705TSV
	706TSA
	MDT-X7000

10~11" TFT LCD Monitor		12~16" TFT LCD Monitor		Mini PC / Car PC
	1020YV		1200TS		MP-SC3
	1020TSV		1210YR		MP-SC10
	1026TSA		1530YR		MP-FL11
	1040TS

Other Products
	Other:

What materials would you like to receive?
 

	Product Catalog	Via:	Selection E-mail Fax Regular Mail
	Price Quotation	Via:	Selection E-mail Fax Regular Mail
	Purchase Sample

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