Matrox Authorized Reseller Application

*denotes required fields

Corporate information

Company		Telephone
Address		E-mail
City		Language
Country		Website address
Province/State
Postal/zip code

Billing Address

	Billing information is the same as above address
Company
Address
City
Country
Province/State
Postal/zip code

1. Sales contact		2. Technical support contact
Name		Name
Position		Position
Tel		Tel
E-mail		E-mail
3. Demo contact		4. Purchasing contact
Name		Name
Position		Position
Tel		Tel
E-mail		E-mail
5. Financial contact		6. Marketing contact
Name		Name
Position		Position
Tel		Tel
E-mail		E-mail

Number of employees
Number of field sales people
Number of inside sales people
Number of technical support people
Number of demo artists
Date of company establishment
Specify the dates of your financial year: (i.e. April 1 - March 31)	–
Number of offices/outlets
Location of offices
Do you have demo facilities? Yes No If yes, what are the sizes of the facilities?
For which editing products do you maintain a demo system?
Is your facility equipped to integrate and test turnkey systems? Yes No

Forecasted revenue

	Current year	Next year
Company total:

Market information

Please indicate what percentage of your business is represented by each of the following markets:

Broadcast	%	Event videography	%
Consumer/hobbyist	%	Government	%
Post production	%	Independent film	%
Industrial/corporate	%	other	%
Education	%

Product line information

Please indicate the products that you sell.

	Manufacturer model	Unit volume per month	Estimated revenues per year
Editing hardware/ software
Computers	Apple HP IBM White Box other
Video equipment	Sony Panasonic JVC Canon other
Equipment rental
Training services
Post-production services

Thank you for your application. Please note that submitting this application does not grant you authorization.
A Matrox account representative will contact you to review the details of the program.

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