Matrox Graphics Distribution Application

This questionnaire is voluntary. Answers are used to evaluate applications for "Distributor" status.
This document is not a contract and does not bind either Matrox or the company filling this out to anything.
The information contained here can change without notice. Matrox is not responsible for your use or interpretation of this questionnaire.

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Step 1 of 5

Corporate information

*Complete Company Name
(Note: if this company is registered under a different company name or otherwise affiliated to another entity, please provide additional details)

Additional Details (if applicable)

Parent Company
(Please identify the holding company that owns the company filling out this document - if applicable)

Company Address

*Street Name *Telephone
*Street Number Fax
*City *E-mail
*Country Preferred language
Province/State
*Language of communication with Matrox
Postal/zip code    

Billing Address

  Billing information is the same as above address
*Street Name
*Street Number
*City
*Country
Province/State
Postal/zip code