If you wish to be a distributor of iScan Products, fill out the fields below and press the Submit button. The information will be forwarded to iScan's Reseller staff, who will contact you after the Application has been reviewed.

General Information

Company Name:
Billing/Mailing Address:	City	State	Zip/Postal Code
Shipping/Street Address (No P.O. Boxes):	City	State	Zip/Postal Code
Main Telephone Number:	Main Fax Number:	Web Address:
President/CEO/Director Name:	Title:	Phone Number:	E-Mail Address:
Primary Contact Name:	Title:	Phone Number:	E-Mail Address:
Sales Contact Name:	Title:	Phone Number:	E-Mail Address:
Technical Contact Name:	Title:	Phone Number:	E-Mail Address:

Company Information

Years in Business:	Years in DMS:
Total Annual Sales:	% From DMS:	# DMS Sold to Date:
# of Employees in Company:	# of Salespeople:	# of Salespeople for DMS:
# of Support Staff:	# of Support Staff for DMS:

Coverage

Vertical Markets you Specialize In (Check all that apply):
Automotive	Banking/Finance	Customer Service	Federal Government
Insurance	Law Enforcement	Legal	Local Government
Medical	Manufacturing	Comm./Computers	Real Estate
State Government	Transportation	Pharmaceutical
Other

Technical Knowledge:

What operating systems/networks do you have successful installations with (check all that apply):
Windows 2000/XP	Windows Vista	Windows Server 2000/2003
What Database Management Systems (DMS) do you have successful installations with (check all that apply):
SQL Server	Oracle	Other
What other DMS products (other than iScan) are you certified/authorized to sell? What level of certification have you obtained?
What scanners do you sell?
Please list any other hardware items that you sell.
What software products do you sell?

Other:

Briefly describe your marketing plan for DMS:

Fields in Bold are required.

Thank you for sending your Application. An iScan Representative will be in contact with you after the Application is reviewed.